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Employers

Employer Bulletin

All Employers
Vol. 17, No. 23
November 17, 2000

Bulletin Contains Health Insurance Reporting Forms for 2001

The 2001 Health Insurance Additions, Deletions and Change Reports; Monthly Coverage Reports; and Summaries for 2001 are enclosed with this Employer Bulletin. These forms may be downloaded from our Internet site at etf.wi.gov. We have also included mailing labels to use when remitting reports to the Department of Employee Trust Funds (ETF).

It is critical that you destroy any old health reporting forms and use the updated versions of these forms. Also, please make sure you are using the most recent revision of the following forms:

  • Health Insurance Application (ET-2301), REV 01/2000
  • Health Insurance Application(ET-2302), REV 01/2000 (UW Grad Assistants only)
  • Health Insurance Information Change (ET-2329), REV 09/2000

If you have any questions about the use of a particular form, please call our Employer Communication Center at (608) 264-7900. If you need additional reporting forms or applications, please contact the forms request line of the Supply and Mail Services Section at (608) 266-3302. You can also e-mail us for inquiries and forms on our Internet site at etf.wi.gov.

Important Reminder for Completing Health Insurance Applications and Corresponding Reports

It is extremely important that the monthly reporting forms are complete and accurate. When hiring a new employee, the "Prospective Date of Coverage" entered on the Health Insurance Application must agree with the date entered on the Monthly Additions Report (ET-2610) in the "Effective Date" column.

When completing the Monthly Deletions Report (ET-2612) for someone, who is terminating employment, the "Event Date" should be the same day as the employee's termination date.

January 2001 Health Insurance Reports Due Soon

The January 2001 Health Insurance Reports are due Wednesday, December 20, 2000. ETF would appreciate receiving your January 2001 reports as soon as possible, given the volume of changes as a result of Dual-Choice.

2001 Dual-Choice Reporting Instructions

Dual-Choice transactions should be entered on the January 2001 Health Insurance Reports. Submit two sets of Additions, Deletions, and Change Reports. One set will include Dual-Choice elections and the second set will include regular monthly transactions. Please be sure to write "DUAL- CHOICE" on the Dual-Choice set and "REGULAR TRANSACTIONS" on the regular transaction set. It is important to keep the Dual-Choice transactions separate from the regular transactions because statistics are monitored separately for these two different types of transactions.

January 2001 Health Insurance Reports will include:

  1. Two copies of your Summary and the corresponding monthly Coverage Reports.
  2. Two copies of the Additions, Deletions, and Changes Report that reflect regular monthly transactions (titled "Regular Transactions").
  3. Two copies of the Additions, Deletions, and Changes Report that reflect Dual-Choice transactions (Enrollment Types 40 and 43 titled "Dual-Choice").
  4. NOTE: Each entry on the Additions Report must indicate the suffix number of the previous plan (i.e., the employee's current plan). Do not substitute the name of the plan for the suffix.
  5. Each entry on the Deletions Report must indicate the suffix number of the newly selected plan. Do not substitute the name of the plan for the plan suffix.
  6. Complete Deletions Reports for each plan showing employees leaving plans at year-end. For example, employees under Physicians Plus - Southeast (suffix code .75), no longer available as of January 1, 2001 switch to Dean Health Plan (suffix code .15). Include these individuals' names, etc. on Physicians Plus - Southeast Deletions Report.
  7. Complete Coverage Reports showing the contracts deleted during the month of December. Complete Coverage Reports for the Plans that are not offered as follows:
    • Enter the number of contracts in December and on line 3 deletions indicate the number of contracts being deleted.
    • Total Contracts in effect = 0.

It is important that you follow these instructions because Dual-Choice statistics are used to track the movement of individuals between the participating plans and counties. The information is then used in the rate setting process for the Group Health Insurance Program. Deviations from these instructions must be pre-approved by submitting a written request and sample forms to:

Rick Parpart
Division of Employer Services
Employee Trust Funds
PO BOX 7931
MADISON WI 53707-7931

E-mail rick.parpart@etf.state.wi.us

For questions about reporting requirements, call Rick Parpart at (608) 267-2198.

Reminder: Assemble Health Insurance Reports Correctly for Best Possible Service

The start of a new year is a good time to review the proper way to assemble your monthly health insurance reports. Following these instructions will ensure the prompt and efficient processing of your reports by both ETF and the designated plans. Please assemble your reports in the following order (you will end up with two sets of reports in descending order):

1. ETF Copies:

  1. Summary with a check (if paying by check) paper clipped to the front.
  2. Monthly Coverage Reports-these should be placed in the order that they appear on the Summary. Corresponding forms should be attached (stapled in the upper left corner) to the respective Coverage Report in the following order:
    1. Additions Report
    2. Deletions Report
    3. Changes Report

2. Carrier Copies:

  1. Make a photocopy of the Summary and staple your check stub, WiSMART document or a photocopy of the check to the back of the photocopied Summary.
  2. Monthly Coverage Reports-these should be placed in the same order as they appear on the Summary. Corresponding forms should be attached (stapled in the upper left-hand corner) to the respective Coverage Report in the following order:
    1. Health Applications and Transfer Reports-placed in the order they appear on the Additions Report.
    2. Additions Report.
    3. Transfers and/or Cancellation Reports as listed on the Deletions Report.
    4. Deletions Report.
    5. Health Applications related to the Changes Report.
    6. Changes Report.

Mail both sets of reports to:

Division of Employer Services
Department of Employee Trust Funds
PO BOX 7931
MADISON WI 53707-7931

For questions about the proper way to assemble your monthly health insurance reports, call our Employer Communication Center at (608) 264-7900.

Late Dual-Choice Applications

If you received any late 2001 Dual-Choice Applications, follow the instructions in Subchapter 406 of the Health Insurance Employer Administration Manual (ET-1118 revised 1/97 for state agencies; ET-1144 revised 6/97 for local employers). Please forward a copy of the application, the letter from the employee and your memo to Mary Hensen, Department of Employee Trust Funds, PO Box 7931, Madison WI 53707-7931 or send via fax (608) 266-5801 no later than December 15, 2000.

Updated 2000-2001 Plan Address List

Attached to this Bulletin is a revised copy of the 2000-2001 Plan Address/Phone/Fax # List. The address for CompcareBlue-Northeast has been changed, as well as the contact names and phone numbers for CompcareBlue Aurora/Family and CompcareBlue Southeast. Most of the other updates are zip code changes.

2000-2001 PLAN ADDRESS/PHONE/FAX # LIST

FOR SENDING HEALTH APPLICATIONS TO THE PLAN


PLAN/ADDRESS

CONTACT NAME/PHONE/FAX #

ATRIUM HEALTH PLAN (.39)
2215 VINE ST STE E
HUDSON WI 54016-5862

CINDY FODROCZI
800-535-4041
FAX 715-386-8326

BLUE CROSS BLUE SHIELD UNITED OF WISCONSIN -
STANDARD PLANS AND SMP
(.01-.05, .A1-.A4)
401 W MICHIGAN ST
MILWAUKEE WI 53203-2896

LISA KROENER
920-923-8343
FAX 920-923-7572

COMPCAREBLUE - AURORA/FAMILY (.16)
401 W MICHIGAN ST
MILWAUKEE WI 53203-2896

CUSTOMER SERVICE
888-239-9514
FAX 608-348-5168

COMPCAREBLUE - NORTHEAST (.14)
ATTN: ENROLLMENT DEPT
PO BOX 110
FOND DU LAC WI 54936-0110

MARLENE ADELMEYER
920-923-8304
FAX 920-923-7572

COMPCAREBLUE - NORTHWEST (.13)
2270 EASTRIDGE CTR
EAU CLAIRE WI 54701-3409

SHEILA CAREY
715-836-1955
FAX 715-836-1299

COMPCAREBLUE - NORTHWOODS (.12)
PO BOX 848
STEVENS POINT WI 54481-0848

CUSTOMER SERVICE
800-258-5299
FAX 715-345-1508

COMPCAREBLUE - SOUTHEAST (.11)
401 W MICHIGAN ST
MILWAUKEE WI 53203-2896

CUSTOMER SERVICE
888-239-9514
FAX 608-348-5168

DEAN HEALTH PLAN (.15)
1277 DEMING WAY
MADISON WI 53717-1971

CONNIE BREUNIG
608-827-4034
FAX 608-836-9620

GROUP HEALTH COOPERATIVE - EAU CLAIRE (.30)
PO BOX 3217
EAU CLAIRE WI 54702-3217

MARY GLASSBRENNER
715-552-4300
FAX 715-836-7683

GROUP HEALTH COOPERATIVE - SOUTHCENTRAL(.35)
PO BOX 44971
MADISON WI 53744-4971

LYNN VER HELST
608-251-4156
FAX 608-257-3842

GUNDERSEN LUTHERAN HEALTH PLAN (.37)
1836 SOUTH AVE
LA CROSSE WI 54601-5494

CINDEE BOTTCHER
608-775-8084
FAX 608-775-8060

HUMANA EASTERN (.21) WESTERN (.22)
111 W PLEASANT ST
MILWAUKEE WI 53212-3976

SARAH MCCUBBINS
502-580-7380
FAX 414-223-2235

LACROSSECARE PLUS (.55)
PO BOX 188
LA CROSSE WI 54602-0188

CUSTOMER SERVICE
877-832-1823
FAX 608-781-9654

MEDICAL ASSOCIATES (.63)
700 LOCUST ST STE 230
PO BOX 5002
DUBUQUE IA 52004-5002

LAURA BOGE
319-556-8070
FAX 319-556-5134

MERCYCARE (.64)
PO BOX 2770
JANESVILLE WI 53547-2770

BETSY FULMER
800-752-3431 OR 608-758-7705
FAX 608-752-3751

NETWORK HEALTH PLAN - FOX VALLEY (.70)
PO BOX 120
MENASHA WI 54952-0120

STEVE WOLF
920-720-1361
FAX 920-720-1900

PHYSICIANS PLUS - SOUTH CENTRAL (.74)
22 E MIFFLIN ST
PO BOX 2078
MADISON WI 53701-2078

CUSTOMER SERVICE
800-454-5015 OR 608-282-8900
FAX 715-260-7367

PREVEA HEALTH PLAN (.47)
PO BOX 11625
GREEN BAY WI 54307-1625

JEFF MARQUARDT
920-436-4119
FAX 920-490-6944

SECURITY HEALTH PLAN OF WI, INC (.71)
PO BOX 8000
MARSHFIELD WI 54449-8000

SANDRA SMITH
800-472-2363 OR 715-221-9623
FAX 715-221-9500

TOUCHPOINT HEALTH PLAN (.94)
5 INNOVATION CT
PO BOX 507
APPLETON WI 54912-0507

JAN EGGERT
920-831-6993
FAX 920-831-6886

UNITY HEALTH PLANS
COMMUNITY (.40) UW-HEALTH (.92)
840 CAROLINA ST
SAUK CITY WI 53583-1374

KATHY HUELSEMANN
608-643-1403
FAX 608-643-2564

VALLEY HEALTH PLAN (.65)
2270 EASTRIDGE CTR
PO BOX 3128
EAU CLAIRE WI 54702-3128

JAN LEVENDUSKY
715-836-1216
FAX 715-836-1298

 

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