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Employers

Employer Bulletin

State Agencies & Local Health Employers
Vol. 20, No. 17
November 11, 2003

Bulletin Contains Health Insurance Reporting Forms for 2004

The 2004 Health Insurance Additions, Deletions, and Change Reports, Monthly Coverage Reports, and Summaries for 2004 are enclosed with this Employer Bulletin. We have also included mailing labels to use when remitting reports to the Department of Employee Trust Funds (DETF).

It is critical that you destroy any old health reporting forms and only use the new reports when reporting for 2004. Also, please make sure you are using the most recent revision of the following forms:

  • Health Insurance Application (ET-2301), Rev. 8/2003
  • Health Insurance Application (ET-2302), Rev. 8/2003 (UW Grad Assistants only)

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. The reporting forms may also be downloaded from the Employer Section of our Internet site at http://etf.wi.gov.

Important Reminder for Completing Health Insurance Applications and Corresponding Reports

It is extremely important to have complete and accurate monthly reporting forms. 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.

2004 Dual-Choice Due Dates and Reporting Instructions

The January 2004 Health Insurance Reports are due Monday, December 22, 2003. DETF would appreciate receiving your January 2004 reports as early as possible, given the volume of changes as a result of Dual-Choice.

Historically, 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 now 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 2004 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, 2004.
  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 ETF Coverage Report 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 within the "From" column 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 within the "To" column 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 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:

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

Improvements in the reporting process and revisions of the Health Insurance Application form require a few changes to the assembly of health insurance reports. Following these instructions is required and will ensure the prompt and efficient processing of your reports by both DETF 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. DETF Copies:

  1. Summary with a check (if paying by check) attached (paper clip) 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. Health Applications and Transfer Reports - placed in the order they appear on the Additions Report.
    3. Deletions Report
    4. Transfers and/or Cancellation Reports as listed on the Deletions Report.
    5. Changes Report
    6. Health Applications related to the 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. Additions Report.
    2. Deletions Report.
    3. 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 2004 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 Wendy Pink, Department of Employee Trust Funds, P.O. Box 7931, Madison, WI 53707-7931 or send via fax (608) 266-5801.

 

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