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Employers

Employer Bulletin

All State and Local Employers
Vol. 20, No. 15
October 30, 2003

Plans Mail Annual Status Letters; Pharmacy Benefit Manager ID Card Reminder

Annual Student/Disabled Dependent Status Letters

The Department of Employee Trust Funds (DETF) annually requires participating health insurance plans to send out the full-time student/disabled dependent status letter, which is attached for your reference. Health plans were allowed to begin mailing the letters on October 15. Plans are permitted to terminate dependents if no reply is received by December 1, 2003. The termination date for former dependents is the last date of eligibility, which in most cases is December 31, 2003.

By December 8, 2003, plans will forward to DETF and each employer a list of dependents, whose coverage has been or will be terminated. This list will be in Excel spreadsheet format with the following fields:

  • Carrier Code
  • Subscriber Group Number
  • Subscriber SSN
  • Subscriber Last Name
  • Subscriber First Name
  • Dependent SSN
  • Dependent Last Name
  • Dependent First Name
  • Change from Family to Single Coverage (yes/no)
  • Termed due to non-Response (yes/no)

When family coverage remains in force but a dependent is removed from coverage, the employer must have the subscriber complete an Information Change Form (ET-2329) deleting the dependent from the existing family contract. The employer must also issue a Continuation/Conversion Notice (ET-2311) to the dependent.

The employer must request a completed Health Insurance Application (ET-2301) from an employee changing from family to single coverage. In addition, the employer must issue a Continuation/Conversion Notice (ET-2311) to the dependent.

The plan will reinstate coverage back to the date of termination if evidence of the dependent's continued eligibility is later provided to the health plan before December 30. The plan will notify DETF and the employer by January 6, 2004, of the reinstated dependents. An Information Change Form (ET-2329) will not be required in these cases. If an employee does not return the questionnaire to the health plan by Tuesday, December 30, 2003, they must complete an Information Change Form to reinstate the eligible dependent.

Even if an employee switched health plans during Dual-Choice, the questionnaire must be returned to the plan that initially sent it. DETF will notify the new health plan based on the Dual-Choice selection.

NOTE: Employees must return questionnaires to CompcareBlue North even though the plan will no longer be available in 2004. CompcareBlue North will be required to forward to DETF and to each employer, a list of dependents whose coverage will be terminated.

Pharmacy Benefit Program Information

Identification Cards

Subscribers will receive two identification (ID) cards for 2004, one from their health plan and one from the Pharmacy Benefit Manager (Navitus Health Solutions). Members will need to present their Navitus ID card to their pharmacist when filling prescriptions. ID cards will be mailed to participants in December 2003.

Further information regarding the PBM can be found on DETF's Internet site at http://etf.wi.gov/pbm.htm or by contacting Navitus customer service at:

Navitus Health Solutions
5 Innovation Court
Appleton, WI 54912
Phone: (toll free) 866-333-2757
www.navitushealth.com

Questions regarding the student/disabled dependent letter or Pharmacy Benefit Manager should be directed to the Employer Communication Center at (608) 264-7900