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Employers

Employer Bulletin

Local Employers
Vol. 17, Local G
September 11, 2000

Dual Choice Enrollment Period Set for October 2-20, 2000

The Group Insurance Board has designated October 2-20, 2000 as the Dual-Choice Enrollment period for coverage effective January 1, 2001. Sufficient quantities of the It's Your Choice 2001 booklets will be supplied to all employers participating in the Wisconsin Public Employers' (Local) Group Health Insurance Program.

Individual letters identifying the lowest-cost plan in your service area and 2001 Health Plan Contacts (ET-1728) will be mailed out later this month. ETF will send the monthly reporting forms for 2001 during the second week of November 2000.

Employees with questions regarding network changes should contact their plans. The state map and the Plan Descriptions in It's Your Choice clarify how these changes may impact employees. Employees should verify with the plans that providers are still available.

Plan Information

1. New Plans

  • CompcareBlue - Northeast (suffix .14) is being offered as a separate network in Brown, Manitowoc and Sheboygan Counties. This plan was part of Compcare-Southeast in 2000.
  • CompcareBlue - Aurora/Family (suffix .16) has many of the same providers that were offered through Family Health Plan. This plan will be newly offered as a non-qualified plan in Milwaukee and Waukesha Counties. Members should call toll-free 1-866-843-9724 before enrolling.
  • SMP is a new option in Adams County, as there is no qualified Health Maintenance Organization (HMO) in this county.

2. Plans no longer available

  • Family Health Plan (suffix .20) - affects Milwaukee and Waukesha Counties.
  • Humana/Emphesys - Racine (suffix .23) - provider network will be offered through Humana-Eastern (suffix .21) - affects Kenosha and Racine Counties.
  • HMP-90 North Central (suffix .44) - affects out-of-state, Barron, Chippewa, Clark, Dunn, Eau Claire, Langlade, Lincoln, Marathon, Marinette, Oconto, Oneida, Portage, Price, Rusk, Taylor, Vilas, Washburn and Wood Counties.
  • Network - Community (suffix .69) - affects Calumet, Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Washington and Waukesha Counties.
  • Physicians Plus Southeastern (suffix .75) - affects Milwaukee, Ozaukee, Washington and Waukesha Counties.

Current members of these plans must select another for 2001. All of these plans will notify current members of the change. If an election is not made, an application will have to be obtained for the Standard Plan.

3. SMP is no longer available in the following counties:

  • Marinette County, due to expanded availability of an alternate plan (Prevea Health Plan) in this county. Subscribers enrolled in SMP must select another plan for 2001. If a new plan is not selected, participants will have to receive medical care from SMP providers in a county in which SMP is still offered.
  • Ashland and Pepin Counties, due to Compcare-Northwest now becoming a qualifying plan in those counties. Subscribers enrolled in SMP must select another plan for 2001. If a new plan is not selected, participants will have to receive medical care from SMP providers in a county in which SMP is still offered.

4. Plan name changes

  • Humana/Emphesys - Milwaukee (suffix .21) will change to Humana-Eastern (suffix .21)
  • Humana/Emphesys - Wisconsin (suffix .22) will change to Humana-Western (suffix .22)

No action by the subscriber is necessary as a result of these name changes.

5. Plan Provider Network Changes

  • Compcare - Northwoods is no longer available as a non-qualifying plan in Waupaca County.
  • Compcare - Southeast is no longer available in Brown County. CompcareBlue - Northeast is being offered as a separate network.
  • Dean is no longer available as a non-qualifying plan in Green County.
  • Humana/Emphesys - Wisconsin (now Humana-Western) is no longer available in Jackson County. It is being offered as a new non-qualifying plan in Barron, Burnett, Calumet and Dodge Counties. It is being offered as a qualifying plan in Dunn County.
  • Physicians Plus - Southcentral is no longer available in Jefferson, Juneau, Lafayette, Marquette, Richland, Sauk, Walworth and Waukesha Counties.
  • Prevea is no longer available as a non-qualifying plan in Shawano County.
  • Security is being offered as a non-qualifying plan in Washburn County.
  • Touchpoint is being offered as a non-qualifying plan in Marquette County and as a qualifying plan in Door County.
  • Unity - Community and Unity-UW Health have made a number of significant network changes. Subscribers outside Dane County should verify whether their providers remain in the same Unity network for 2001.
  • Unity-UW Health will only be offered in Dane County.
  • Unity-UW Health is no longer available in Rock County.
  • Unity-Community will be offered in Columbia and Jefferson Counties. Current members of Unity-UW Health living in Columbia or Jefferson Counties should be encouraged to select another plan for 2001 and file an application. If these members file no applications, they will only be allowed to use the providers listed with Unity-UW Health in Dane County.
  • Other network changes appear on the map on page A-3 and the Plan Descriptions in section F of It's Your Choice or subscribers should contact the plans directly.
  • The subscriber's current plan is required to provide a list of all plan providers that will not be available in 2001. Subscribers should contact their plans if they have not received this information by October 6th.

6. Changes to the Uniform Benefits, and SMP prescription drug co-payment and annual out-of-pocket maximum

  • Co-payment will be $5 for generic drugs and $10 for brand name drugs for up to a 34-day supply.
  • Annual out-of-pocket maximum will be $240 per individual and $480 for a family.

7. New Coverage under Uniform Benefits, Standard and SMP

  • Pharmacotherapy for smoking cessation will be covered as any other prescription. This benefit will provide coverage for smoking cessation products that require a written prescription and are prescribed by a plan provider, such as Zyban, nicotine inhalers or sprays. Over-the-counter products are not covered. Coverage is limited to one three-month course of pharmacotherapy per contract year.

The health plans may require a referral or pre-authorization for these products. Participants should contact the plans directly during Dual-Choice to determine how the plan will administer the benefit.

8. Other information about Uniform Benefits

  • Routine maintenance and replacement tires and batteries for durable medical equipment will be covered. Participants still must obtain prior authorization from the plan if the purchase will exceed $200.
  • There are no annual dollar maximums for mental health services in 2001. The dollar maximums continue to be suspended due to the federal Mental Health Parity Act. Annual day limits for inpatient mental health services and annual dollar maximums for alcohol and drug abuse treatment remain in force and are combined with mental health services for determining if benefits for alcohol and drug abuse have been exhausted.
  • The uniform benefits are included in the ETF website at http://badger.state.wi.us/agencies/etf. Additional information about the health insurance program and other insurance programs offered to state employees is also available at this site.

General Information about Dual-Choice

Dual-Choice provides an opportunity for insured employees to change health insurance plans and/or change from single to family coverage without a waiting period for pre-existing conditions.

Important Note:

  1. Even if employees want to continue participating in their current plan, they should still do the following:
  2. Verify that their current plans will be available in their areas for 2001.
  3. Review the 2001 premiums with the employer for any change in the employee share.
  4. Verify that selected physicians, clinics and/or hospitals will be available under their plans in 2001.
  5. Review changes in benefits by reading the "Notable Plan and Program Changes" section, as well as the individual plan descriptions found in the It's Your Choice booklet.
  6. Call the health plan directly with specific benefit or provider questions.

Completed applications to change plans must be returned to employers no later than 4:30 p.m., Friday, October 20, 2000.

Employees may select any alternate plan regardless of their resident counties, but should be sure that the providers are within reasonable distance for medical care. It's Your Choice booklets identify geographic areas covered by each plan.

The Dual-Choice period for active and retired employees, as well as former employees, who have continued their insurance, takes place simultaneously.

ETF will mail It's Your Choice booklets, complete with special application forms, directly to retirees (WRS annuitants) and former employees (health insurance continuants). If you have employees that want to change plans and who will retire effective January 1, 2001 or later, they must complete applications as active employees. Changes in annuitant coverage will be handled by ETF when employees apply for annuitant benefits. However, employers with employer paid annuitants should provide these subscribers with the 2001 It's Your Choice booklets.

NOTE: Forward all "carrier advance registration" copies of the Dual-Choice applications to the plans by Friday, November 10, 2000. Please make sure that the employee selected a primary care physician and that the employer portion of the application is completed.

Specific Instructions

Booklet Distribution

It's Your Choice booklets must be distributed in a timely manner to all insured employees. Please remind employees to keep the booklet as a reference for the plan year. These distributions include:

  1. Insured employees that have indicated they do not wish to make a change during Dual-Choice. Remind these employees that they remain responsible for understanding the information in the booklet and that it serves as their certificate of coverage if they are enrolled in an alternate plan.
  2. Insured employees on layoff or leave of absence. Employees who have let their health insurance lapse while on leave of absence or layoff should be advised that they are eligible to make a Dual-Choice election within 30 days of returning from the leave or layoff.
  3. Employer-Paid Annuitants. Remind these annuitants not to complete the application in the back of their It's Your Choice booklet. Instead, these annuitants must complete a Health Insurance Application (ET-2301) if they want to change plans during Dual-Choice. The application in the back of their It's Your Choice booklet is for WRS annuitants and continuants only.

Special Note:ETF does not distribute Health Insurance Applications (ET-2301) to employers along with copies of It's Your Choice booklets, due to the small percentage of employees actually electing to change health plans during the Dual-Choice Enrollment period. To request applications, or if you need Health Insurance Information Change forms (ET-2329), contact ETF Supply and Mail Services Section at (608) 266-3302. Indicate your Employer name and Identification Number (EIN), location, form name and number, and the quantity of forms desired. Please indicate that your request is Dual-Choice related.

Procedure for New Employees

New employees initially eligible for coverage on November 1 or December 1, 2000 must file two applications during their regular enrollment period if they wish to enroll in a different plan for 2001. The first application covers the period from the date of initial coverage through December 31, 2000. The second application changes their health insurance to the plan of their choice for 2001, and must have the "Dual-Choice" box checked.

Procedure for Employees Who Terminate in November or December After Making a Dual-Choice Election

For employees terminating in November or December after making a Dual-Choice election, the plan they elected during Dual-Choice is the plan to record in the "plan information section" of the Continuation-Conversion Notice (ET-2311).

If an employee's termination date is such that he or she will still be eligible for health insurance coverage after January 1, 2001, and the employee has also notified your office within 30 days of a move, a new health insurance application must be submitted. The appropriate Transfer, Deletion and Addition Reports must be attached to the corresponding Coverage Reports. In this instance, the plan information indicated on the Continuation-Conversion Notice (ET-2311) should reflect the new plan.

If you are notified that an employee moved out of the service area after the termination date but prior to the date the coverage ends, report the applicable change as you would for any other active employee. However, if the effective date of the move is the same as or after the date the coverage ends, ETF will make the applicable plan contacts.

Procedures for Withdrawing Dual-Choice Elections

Employees may rescind Dual-Choice elections by notifying their employers in writing prior to December 31, 2000. The written request should be filed with the employee's records. When you receive a request to rescind, make three copies of your ply of the Dual-Choice application and write "Rescind "across each copy. Forward one copy to the current plan, one copy to the plan indicated as "Plan Selected" and send one copy to ETF.

Please contact the Employer Communication Center at (608) 264-7900 with all questions associated with health insurance eligibility and reporting, including any concerns related to Dual-Choice or this specific Employer Bulletin.

 

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