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Employers

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:

  1. 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.
  2. 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:

  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. 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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