Vol. 16, No. 15
September 28, 1999
Application Processing Instructions Provided For Dual-Choice
The Department of Employe Trust Funds (ETF) has developed special
health insurance processing instructions for use during the year
2000 Dual-Choice Enrollment period, October 4-22, 1999. These instructions
will help you streamline the processing of Dual-Choice Health
Insurance Applications (ET-2301 for state and local government
employes; ET-2302 for University of Wisconsin graduate assistants)
and Health Insurance Information Change forms (ET-2329)
during this busy time of the year.
Please process your Dual-Choice applications for the year 2000
Send the Advanced Carrier ply of your Dual-Choice applications
on a weekly basis directly to the plans. All Advance
Carrier plies must be forwarded to the plans by November 5,
1999. This approach will assist ETF in ensuring that your
employes receive their new subscriber cards prior to January
Send the ETF ply of your Dual-Choice applications on a weekly
basis directly to ETF. All ETF plies must be for-warded to ETF
by November 5, 1999.
Provide the following information on each Dual-Choice
2000 Health Insurance Application:
Participant County – This county code represents the county
in which your employe resides.
Physician County – This county code represents the
county in which your employe receives primary care.
Payroll Representative Signature
Date Received by Employer
Date Employment Began – This box can be left blank,
or insert the date on which employment began with your entity.
Effective Date of Coverage
Separate each type of application form (ET-2301, ET-2302, and
ET-2329). Within each form type, separate enrollment type 40
from enrollment type 43. Within enrollment type 40 or 43, separately
bundle applications by employe type.
Prepare a cover sheet for each bundle with the following information
instead of completing the section "Employer Completes Area Below"
on each health insurance form (ET-2301, ET-2302 and ET-2329):
Type of Application form (indicate one):
Enrollment Type - 40 or 43
Name of Employer
We hope these health insurance application processing instructions
will help you accomplish your tasks for Dual-Choice 2000 in a timely
and efficient fashion. The year 2000 Health Insurance Reporting
forms, Monthly Coverage Reports and Summaries, and
further reporting instructions will be sent to you in late November.
Remind Your Employes to contact the plans directly with
questions, and provide plans with current mailing addresses.
Employes who request verification or explanation of service area
and/or provider availability related to Dual-Choice 2000 must contact
the plans directly. In doing so, your employes will receive the
most up-to-date information regarding providers or service areas.
PLEASE NOTE: In order to receive information pertinent to the Group
Health Insurance Programs administered by ETF, your employes must
identify themselves as a State of Wisconsin Plan employe (State
and University of Wisconsin employes), or a Wisconsin Public Employer
Plan employe (local government or school district employes).
Please remind your employes who participate in the Group Health
Insurance plan that they are responsible for providing their current
mailing addresses to their respective plans. The plans will take
employe address information over the telephone and report any changes
to ETF. Plans indicate that they are unable to contact many current
subscribers due to incorrect addresses on file. Once mailing addresses
are updated, employes will receive provider information in a timely
fashion. This includes information related to student status, which
will enable dependents to continue their current health insurance.
If you have questions related to Dual-Choice or questions about
health insurance eligibility and reporting, please contact the Employer
Communication Center at (608) 264-7900.
Local Government Employes and UW Graduate Assistants
The 2000 It's Your Choice booklets for local government
employes and UW graduate assistants contain a Health Insurance
Application for continuants and annuitants. These applications
(ET-2334 in the local government booklet; ET-2332 in the UW graduate
assistant booklet) are to be used only by inactive employes
and annuitants that pay their health insurance premiums
directly to the plan. These applications are not
to be used by your active employes.
Active employes must complete the Group Health Insurance Application
(ET-2301 for local government employes; ET-2302 for UW graduate
assistants) and submit the applications to you. If an active employe
incorrectly completes the application and submits it to you, record
the date you received the incorrect application (for deadline filing
purposes). Then, have the employe immediately complete the proper
application and submit it to you for completion of the employer
section and distribution to ETF and the plans.
If one of your employes submits an incorrect application directly
to ETF in error, ETF will record the date received and return the
incorrect application to you so the appropriate application can
be completed to ensure the requested Dual-Choice change is made.
Please direct any questions to the Employer Communication Center
at (608) 264-7900.