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Employers

Employer Bulletin

State Agencies and Local Health Employers
Vol. 21, No. 13
October 20, 2004

Plans Mail Annual Dependent Status Letters

Pharmacy Benefit Manager (PBM) ID Card Reminder

Annual Student/Disabled Dependent Status Letters

The Department of Employee Trust Funds (ETF) requires that participating health insurance plans annually send the attached status letter to subscribers with full-time student/disabled dependents. Health plans begin mailing the letters the week of October 25-29. Plans are permitted to terminate student/disabled dependents’ health coverage if the subscriber fails to respond to the plan by December 1, 2004. The coverage termination date for former dependents is the last date of eligibility, which in most cases is December 31, 2004.

Note: Subscribers’ failure to complete and return the student/disabled dependent status questionnaire may result in denied/delayed claims and prescription drug benefits for dependents.

Subscribers switching health plans during the 2005 Dual-Choice enrollment period must complete and return the dependent status letter’s questionnaire to the health plan that initiated the letter, not the health plan selected for 2005. ETF will notify the new health plan (the participant's Dual-Choice selection) of any dependent status changes based on the questionnaire. Subscribers covered by Valley Health Plan in 2004 must return the student/disabled dependent status questionnaires to Valley Health Plan even though the health plan will no longer be available in 2005.

Health plans are not allowed to accept verbal responses to the student/disabled dependent status questionnaire.

Plans will forward a list of dependents whose coverage has been or will be terminated to ETF by December 6, 2004. The list, in Excel spreadsheet format, will contain 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)

By December 16, 2004, ETF will forward a report (Excel spreadsheet format) to each employer, compiled from the data submitted by the health plans, notifying them of their subscribers' terminated dependents.

For changes from family to single coverage resulting from a change in student/disabled dependent status, employers must:

  • Request a Health Insurance Application (ET-2301) from any subscriber changing from family to single coverage.

Issue a Continuation/Conversion Notice (ET-2311) to previously covered dependent(s).

In the event family coverage remains in force following removal of a student/disabled dependent from coverage, employers must:

  • Request a completed Health Insurance Information Change form (ET-2329) deleting the dependent from the existing family contract.
  • Issue a Continuation/Conversion Notice (ET-2311) to previously covered dependent(s).

Health plans will reinstate coverage back to the date of termination if the subscriber provides evidence of the dependent’s continued eligibility to the health plan before December 30, 2004. The health plans will notify ETF by January 7, 2005, of any reinstated dependents. A Health Insurance Information Change form (ET-2329) is not required in these cases.

However, questionnaires containing evidence of the dependent’s continued eligibility returned to health plans after Thursday, December 30, 2004, require that the subscriber submit a Health Insurance Information Change form (ET-2329) to the employer reinstating their eligible dependent(s) who were previously removed from coverage. ETF will forward compiled reports of reinstated dependents to employers by January 24, 2005.

Reminder: Pharmacy Benefit Manager (Navitus) ID Cards

The Pharmacy Benefit Manager (PBM), Navitus Health Solutions, will send new ID cards to subscribers only when one or more of the following information changes occur:

  • New health plan selected, including selections made during Dual-Choice,
  • Dependent(s) added or deleted,
  • Group number change, and/or
  • Name change.

Subscribers without any of the changes noted above should continue to use their existing Navitus ID card. Subscribers can request additional copies of their ID card by contacting Navitus customer service at:

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

Please contact the Employer Communication Center at (608) 264-7900 with questions regarding the Student Status Letter or the PBM ID cards.

 

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