Employer Bulletin
State Agencies and Local Health Employers
Vol. 19, No. 19
November 13, 2002
Bulletin Contains Health Insurance Reporting Forms For
2003
The 2003 Health Insurance Additions, Deletions, and Change Reports,
Monthly Coverage Reports, and Summaries for 2003 are enclosed with
this Employer Bulletin. 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 only the new reports when reporting for 2003. Also, please
make sure you are using the most recent revision of the following
forms:
- Health Insurance Application (ET-2301), Rev. 2/2002
- Health Insurance Application (ET-2302), Rev. 3/2001
(UW Grad Assistants only)
- Health Insurance Information Change, (ET-2329), Rev.
11/2001
If you need additional reporting forms or applications, contact
the forms request line of the Supply and Mail Services Section at
(608) 266-3302. The reporting forms may also be downloaded from
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 an employee, who is terminating employment, the "Event
Date" should be the same day as the employee's termination
date.
2003 Dual-Choice Due Dates and Reporting Instructions
The January 2003 Health Insurance Reports are due Friday, December
20, 2002. ETF would appreciate receiving your January 2003 reports
as early as possible, given the volume of changes as a result of
Dual-Choice.
In the past, we have asked employers to submit one set (two copies)
of the January Additions, Deletions, and Change Reports for the
Dual-Choice elections and a second set (two copies) for the regular
monthly transactions because statistics are monitored separately
for these two different types of transactions. We are now able to
gather these statistics through our Health Insurance and Complaint
System and employers need not divide the January transactions
between dual choice and "regular." Please combine
both types of January transactions on the Coverage, Additions, Deletions,
and Change Reports.
January 2003 Health Insurance Reports will include:
- Two copies of your Summary and the corresponding
monthly Coverage Reports for each plan showing all of the contracts
(regular and Dual-Choice) added and deleted for the coverage month
of January, 2003.
- Two copies of the Additions, Deletions, and
Change Reports that reflect both regular monthly transactions
and Dual-Choice transactions (Enrollment Types 40 and 43 titled
"Dual-Choice"). The carrier copies of the Dual-Choice
applications are to be attached to the corresponding Additions
Reports. Complete Deletions reports for each plan showing
employees leaving the plan at year end must be submitted.
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 plan suffix number.
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 number.
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 an integral
part of 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:
Ron Diehl
Division of Employer Services
Employee Trust Funds
PO Box 7931
Madison, WI 53707-7931
E-mail ron.diehl@etf.state.wi.us
Assembly of Health Insurance Reports
The start of a 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 and provide the
best possible service for you if questions arise. Please assemble
your reports in the following order (you will end up with two sets
of reports in descending order):
1. ETF Copies:
- Summary with a check (if paying by check) paper clipped
to the front.
- 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:
- 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 the Employer Communication Center at (608)
264-7900.
Late Dual-Choice Applications
If you received any late 2003 Dual-Choice Applications, follow
the instructions in Subchapter 406 of the Health Insurance Employer
Administration Manual (ET-1118 Revised 1/97 for state agencies
and ET-1144 Revised 6/97 for local employers). Please forward
a photocopy of the application, the letter from the employee and
your memo to Jeanne Nagy, Department of Employee Trust Funds, P.O.
Box 7931, Madison, WI 53707-7931 or send via fax (608) 266-5801.
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