calculators
forms and publications
news
about etf
frequently asked questions
contact etf
site map
video library
related links
home
top of page
home
members retirees employers governing boards careers at etf
 
Employers

Employer Bulletin

State Agencies & Local ICI Employers
Vol. 22, No. 8
May 19, 2005

The Department of Employee Trust Funds (ETF) recently revised Income Continuation Insurance (ICI) brochures and applications.

State of Wisconsin Income Continuation Insurance brochure (ET-2106) and Wisconsin Local Government Employees Income Continuation Insurance brochure (ET-2129)

The State and Local ICI brochures are updated to clarify current policy and include reference to the new supplemental ICI coverage. The revised brochures include the following policy changes:

  1. Supplemental ICI coverage – The Group Insurance Board (GIB) approved offering supplemental coverage for employees with annual salaries exceeding $64,000 and up to a maximum of $120,000.
  2. Employees may continue or elect coverage while on military leave. Should coverage lapse while on military leave, the employee may reinstate the coverage by filing an ICI enrollment application instead of filing through evidence of insurability.
  3. The GIB also approved the following changes to the ICI plan benefit provisions: (These revisions apply to both the State and Local ICI plans unless otherwise indicated.)
    • Issue short-term disability benefits on a monthly basis instead of biweekly. (State employees only.)
    • Base monthly ICI benefits on 30 days regardless of the number of days in a month. Partial monthly ICI benefits are pro-rated using 30 days in a month.
    • Offer direct deposit of short-term disability claim payments for claimants who have received ICI short-term disability benefits for a minimum of six (6) months.
    • Require direct deposit of long-term disability payments.
    • Increase the maximum monthly ICI benefit to $7,500 for claimants with supplemental ICI coverage.
    • Offset paid vacation, paid holiday and paid compensatory time at 100% if payment is made after the elimination period and before returning to part-time employment. (State employees only.)
    • Offset paid vacation, paid holiday and paid compensatory time at 75% if payment is made after the elimination period and after returning to part-time employment. (Local employees only.)
    • Offset part-time earnings from the ICI benefit payment based on the date of the earnings check.

The brochures also include GIB-approved premiums for supplemental ICI coverage. Premiums for supplemental coverage are added to the standard premium to determine the total monthly employee premium.

In early June you will receive a supply of the ICI brochures (ET-2106 or ET-2129) to distribute to all insured employees. You will also receive an additional supply to use for new hires. After receipt of the revised brochures, discard any ICI brochures with a revision date prior to 04/2005.

Questions regarding plan changes should be directed to Broadspire at 1-800-960-0052. Questions regarding ICI coverage (eligibility and coverage reporting questions from employers) should be directed to ETF’s Employer Communication Center at (608) 264-7900.

ICI Evidence of Insurability Application (ET-2308)

Revisions to the ICI Evidence of Insurability Application (EOI) include minor language changes and selection boxes for the new supplemental ICI coverage.

You will receive a supply of this form in early June, along with the revised state and local ICI brochures. After receipt of the revised form, discard any EOIs with a revision date prior to 04/2005. As of July 1, 2005, Broadspire will return, to the employee, applications received with a revision date prior to 04/2005.

Income Continuation Insurance Employer Statement (ET-5351)

Revisions to the ICI Employer Statement require that State and Local employers indicate whether the employee is covered under supplemental ICI. Eligibility for supplemental ICI benefits requires that the employee become disabled after the supplemental ICI coverage effective date. In the event the ICI supplemental coverage effective date is later than the first date of disability, ICI benefits are based on the standard ICI coverage only.

State Agencies Only

State agencies must indicate whether a seasonal/academic, Limited Term Employee (LTE), or project employee worked fewer than 12 months in the calendar year prior to the employee’s last day worked. For most State employees, the ICI benefit is based on the basic salary, excluding overtime, for the last complete payroll period prior to the employee’s first date of disability. ICI benefits for a seasonal/academic, LTE or project employee who worked fewer than 12 months in the calendar year prior to the employee’s last day worked are based on the State earnings from the prior calendar year rounded to the next higher thousand and divided by twelve. ICI benefits for an employee with an interruption of three consecutive months or more are based on estimated earnings. In these cases, employers use the earnings expected to be received during the ensuing twelve months rounded to the next higher thousand and divided by twelve to determine the monthly basis for the ICI benefit.

The most current revision of the ICI Employer Statement (ET-5351) can be found on ETF’s Internet site at http://etf.wi.gov.

Additional ICI Forms

After you receive your initial order, you may order additional State and Local ICI brochures (ET-2106 and ET-2129), Evidence of Insurability Applications (ET-2308) and other ICI forms, by either of the following methods:

  • Photocopy and complete the ICI Forms/Booklets Order Form available on ETF’s Internet site at http://etf.wi.gov. This form is also located in Subchapter 110 of the ICI Administration Manual – Local Government Employers. Fax the form to Broadspire at (781) 270-8666.
  • Complete the ICI Forms/Booklets Order Form available on ETF’s Internet site at http://etf.wi.gov, and e-mail it to

    ICILTDI@choosebroadspire.com.

Should an emergency need for ICI forms arise, call Broadspire at 1-800-960-0052 and provide the following:

  • Employer Name
  • Four-digit employer identification number (EIN) starting with 69-036-
  • Mailing Address
  • Contact Name
  • Contact Phone Number
  • Form Name and Number
  • Quantity of the form or brochure

The Broadspire Correspondence Unit will contact the employer to confirm receipt of the request for forms and provide an estimated shipping date.

Contact Broadspire’s Customer Service team designated for the State of Wisconsin at 1-800-960-0052 for follow-up if orders are not received within 10 business days of the estimated shipping date. Provide the following information:

  • Date the order was first placed and the estimated shipping date.
  • Employer name, EIN and telephone number

Employers with questions about this bulletin should contact ETF’s Employer Communication Center at (608) 264-7900.

 

supporting excellence in Wisconsin public service