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