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Employer Bulletin

State Agencies and Local ICI Employers
Vol. 22, No. 2
January 28, 2005

Board Changes Application of Paid Vacation, Holiday or Compensatory Time for the Local ICI Plan; Board Mandates Multiple ICI Enrollment Applications

The Group Insurance Board (GIB) recently approved a change to the Local Employer Income Continuation Insurance (ICI) Plan. The change, effective January 1, 2005, requires that vacation, holiday or compensatory time earnings paid after the claimant’s elimination period and after the claimant has returned to less than full-time employment be offset from the ICI benefit at a rate of 75%. Previously, claimants who returned to less-than-full-time work, or less than their pre-disability appointment, and were eligible to receive reduced ICI benefits, had their ICI benefits reduced by 100% of the earnings paid for vacation, holiday or compensatory time taken in lieu of working. The approved change aligns the Local ICI Plan language with that of the State ICI Plan.

The Department of Employee Trust Funds (ETF) revised the Income Continuation Insurance Report of Employment and Earnings (ET-5901) to report the earnings for vacation, holiday or compensatory time paid out after the ICI benefit begin date and after the claimant returns to part-time employment. Should a claimant return to part-time employment, you must report any vacation, holiday or compensatory time taken as part of the return-to-work earnings in Section A of the form. An instruction sheet for completing the Income Continuation Insurance Report of Employment and Earnings (ET-5901) is attached to the form and provides special instructions for reporting actual work hours, wages and earnings for vacation, holiday, and compensatory time as well as Worker’s Compensation (WC) temporary benefit.

The revised Income Continuation Insurance Report of Employment and Earnings form (ET-5901) can be found on the Department’s Internet site.

You may also order ICI forms by completing the on-line order form (found on the Employers menu) and mailing, e-mailing or faxing it to Broadspire. Local Government Employers may complete the order form found in Subchapter 110 of the ICI Administration Manual (ET-1145, rev. 12/2004) and mail, e-mail or fax it to Broadspire.)

Mandatory Multiple ICI Enrollment Applications

At its November 16, 2004 meeting, the GIB approved a revision to the State and Local ICI Plans to require an employee employed at more than one employer to file separate ICI applications for each position held. Consequently, effective January 1, 2005, a State employee working part time for two different State agencies must complete two separate Income Continuation Insurance Applications (ET-2307).

In addition, under the revised Plan language, an employee eligible for more than one ICI plan with a different elimination period with the same employer must file a separate application for each position held. For example, employees working part-time for a state agency and part-time in a position eligible for the UW Faculty plan must complete an ICI application for each position due to the elimination period within the UW Faculty plan. Likewise, a person employed part-time with a Local ICI covered employer and also part-time with a State agency is required to fill out two separate enrollment applications because the positions fall under ICI plans with different elimination periods.

If you have questions regarding this bulletin, please contact the Employer Communication Center at (608) 264-7900, or e-mail ETF from the Contact Us page of our Internet site,


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