Vol. 18, Local D
September 13, 2001
Health Insurance Dual-Choice Information
Dual-Choice Enrollment Period for 2002 is set for October
October 8-26, 2001 is the Dual-Choice Enrollment period for coverage
effective January 1, 2002. The Dual-Choice period for active and
retired employees, as well as former employees, who have continued
their insurance, takes place simultaneously. 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. The 2002 It’s Your
Choice booklets will be supplied to all employers participating
in the Wisconsin Public Employers’ (Local) Group Health Insurance
Program for distribution to your covered employees.
Individual letters identifying the lowest-cost plan in your service
area and 2002 Health Plan Contacts (ET-1728) was mailed
to employers on September 12, 2001. An Employer Bulletin
will be sent out in November with additional instructions for Dual-Choice
reporting. If you need reporting assistance contact Ron Diehl at
(608) 266-2737. ETF will send the 2002 monthly reporting forms during
the second week of November 2001.
Dual-Choice Kick-off Meeting Reminder
The annual Dual-Choice Kick-off meeting will be held on Tuesday,
October 2, 2001 from 9:00 a.m. to 11:30 a.m. at Mendota Mental Health
Institute Conference Center, 301 Troy Drive, Madison, Wisconsin.
Directions and a map were provided in Employer Bulletin
Vol. 18, No. 7 dated May 11, 2001. A copy of this Bulletin
is available on ETF Internet site at etf.wi.gov.
The Dual-Choice Kick-off meeting provides an opportunity for you
to receive information from health plan representatives and from
ETF employees regarding health plan changes that will take place
January 1, 2002. Please call the Employer Communication Center
at (608) 264-7900 with questions.
Educational Teleconference Set
ETF is also sponsoring a telephone conference through the UW Educational
Telephone Network (ETN). The conference is scheduled for Thursday,
October 18, from 9:00 a.m. - 10:20 a.m. and will address questions
about the Dual-Choice Enrollment period. To obtain information concerning
the ETN locations in your area, check the ETN web site at http://www.uwex.edu/ics/etn/siteinfo.htm,
or contact the UW-Extension Instructional Communication Service
(ICS) at 1-608-262-1598 or visit our Internet site at etf.wi.gov.
Notable Changes to Administrative Provisions Effective
January 1, 2002
COBRA/Continuation – At the time COBRA/Continuation
is elected, a former covered dependent may elect a different
plan if the dependent resides in a county that does not
include a primary care physician in the subscriber's plan.
The former covered dependent may elect a different plan that
is offered in the county where the dependent lives. The Q&A
section of the It's Your Choice booklet has been
modified to include this change. The Continuation/Conversion
Notice (ET-2311) and instructions in the Group Health
Insurance Employer Administration Manual (ET-1118) will
also be modified to include this change. Watch for further instructions
in a future Employer Bulletin.
EXAMPLE: A dependent ceases to be a full-time
student as of 12/31/2001. The subscriber is enrolled in Dean
Health Plan and lives in Dane County. The dependent however
lives in Milwaukee County where no primary care physician is
available through Dean Health Plan. The former dependent can
select any plan offered in Milwaukee County at the time COBRA/Continuation
Late Dual-Choice Network Change – If
a plan offers more than one network (i.e., Compcare, Humana,
Unity) and the service areas change, a subscriber who fails
to make a Dual-Choice election may change to the appropriate
network within the same plan. The change is effective the first
of the year or the first of the month after the employer receives
the application, whichever is later. Prior to the change, the
subscriber must use providers in the network currently enrolled.
If you receive an application or request from the subscriber
after the October 26, Dual-Choice deadline, process the application
with the later of an effective date of January 1, 2002 or the
first of the month following your receipt of the application.
Lifetime Benefit Maximums – A plan must
provide the subscriber with benefit accumulation information
The state map, found on page A-3 of the It's Your Choice
booklet, has been changed for 2002 to reflect both qualified and
non-qualified plans in each county. In the past, only qualified
plans appeared on the map.
- Plans newly available in these Counties
- SMP is a new option in Marinette County, as there is no qualified
Health Maintenance Organization (HMO) in this county.
- Barron County - Atrium Health Plan (qualifying)
- Bayfield County - Humana-Western (non-qualifying)
- Buffalo County - Health Tradition and Humana-Western (both
- Chippewa County - Atrium Health Plan (qualifying)
- Dodge County - Unity Community (non-qualifying)
- Dunn County - GHC-Eau Claire and Security Health Plan (both
- Eau Claire County - Atrium Health Plan (non-qualifying)
- Fond du Lac County - Dean Health Plan (qualifying)
- Green County - Unity-Community (qualified)
- Outagamie County - Prevea Health Plan (non-qualifying)
- Pepin County - Humana-Western (non-qualifying)
- Price County - GHC-Eau Claire (non-qualifying)
- Richland County - Unity-Community (qualifying)
- Sauk County - Gundersen Lutheran (non-qualifying) and Physicians
- Trempealeau County - Humana-Western (non-qualifying)
- Plans no longer available
- CompcareBlue - Northwest (suffix .13). Note: The current Northwest
provider network will be included in the new CompcareBlue -
North (suffix .12). This change affects subscribers in Ashland,
Burnett, Clark, Douglas, Iron, Pepin, Pierce, Polk, Price, Sawyer,
St. Croix, Taylor and Washburn Counties.
- CompcareBlue - Southeast (suffix .11). This change affects
subscribers in Kenosha, Milwaukee, Ozaukee, Racine, Rock, Walworth,
Washington, and Waukesha Counties.
Current members of these plans must select another plan for 2002.
All of these plans will notify current members of the change.
- SMP is no longer available in the following counties:
- Adams County, due to Unity-Community now becoming a qualifying
plan in this county.
- Green County, due to Unity-Community now becoming a qualifying
plan in this county.
Subscribers enrolled in SMP for these counties must select another
plan for 2002. 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.
- Plan name changes
- LaCrosseCare Plus (suffix .55) will change to Health Tradition
CompcareBlue - Northwoods (suffix .12) will change to CompcareBlue
- North (suffix .12). This change affects subscribers in Forest,
Langlade, Lincoln, Marathon, Oneida, Portage and Wood Counties.
No action by the subscriber is necessary as a result of these
- Plan Provider Network Changes
- Bayfield County - CompcareBlue - Northwest is no longer available
as a non-qualifying plan.
- Columbia County - Network-Fox Valley is no longer available
as a non-qualifying plan.
- Green County - Physicians Plus - SC is no longer available
as a non-qualifying plan.
- Jefferson County - GHC-South Central is no longer available
as a non-qualifying plan.
- Marquette County - Touchpoint Health Plan is no longer available.
- Pepin County - GHC-Eau Claire is no longer available.
- Portage County - Touchpoint Health Plan is no longer available.
- Rock County - GHC-South Central is no longer available.
- The geographic areas of each plan appear on the map on page
A-3. Subscribers should be encouraged to review the Plan Descriptions
in section G of It’s Your Choice and to contact
the plans directly with questions.
- The subscriber’s current plan is required to provide
a list of all plan providers that will not be available in 2002.
Subscribers should contact their plans if they have not received
this information by October 11.
- Notable Changes to the Uniform Benefits for 2002
- Annual prescription drug out-of-pocket maximum will be $270
per individual and $540 for a family.
- Emergency room co-payment will be $40 per occurrence. The
co-payment will continue to be waived if the member is admitted
directly to the hospital.
- One hearing aid per ear will be covered every three years
at 80% (under Durable Medical Equipment [DME] benefit), up to
a maximum of $1,000 per hearing aid. The annual out-of-pocket
maximum of $500 for DME does not apply.
- Extraction of natural teeth and replacement with artificial
teeth because of accidental injury must occur within 18 months
- Changes to Standard and SMP
- Standard Plan - For active employees and annuitants not eligible
for Medicare, the deductible (per person) will increase from
$150 to $250. It will remain $150 for annuitants eligible for
Medicare. The prescription co-pay will change from $3 for all
prescriptions to $5 generic and $15 brand name for all active
employees and annuitants.
- SMP - The deductible (per person) will increase from $100
to $200. The prescription co-pay will change from $3 all prescriptions
to $5 generic and $15 brand name.
- It is important to note that because the Standard Plan and
SMP are self-funded, all premiums go directly for the payment
of claims and the cost of administering the plan.
- Other information about Uniform Benefits
All uniform benefits are included in the ETF Internet site at
Even if employees want to continue participating in their current
plan, they should do the following:
- Verify that their current plans will be available in their areas
- Review the 2002 premiums with the employer for any change in
the employee share.
- Verify that selected physicians, clinics and/or hospitals will
be available under their plans in 2002.
- 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.
- Call the health plan directly with specific benefit or provider
Employees must return completed applications to change
plans to their employers no later than 4:30 p.m., Friday, October
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.
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, 2002 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 2002 It's Your Choice booklets.
NOTE: Forward all "carrier advance registration"
copies of the Dual-Choice applications to the plans by Friday,
November 9, 2001. Please make sure that the employee selects a
primary care physician and that the employer portion of the application
Remind employees to keep their 2002 It's Your Choice booklet
as reference for the entire plan year.
It's Your Choice booklets must be distributed in a timely
manner to all insured employees including:
- Insured employees who 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.
- 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.
- 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.
ETF does not distribute Health Insurance Applications
(ET-2301) to employers along with copies of It's Your Choice
booklets. To request applications, 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 your request is Dual-Choice related.
Remind Employees to Contact the Plans Directly with
Questions, and to Provide Plans with Current Mailing Addresses
Employees who request verification or explanation of service area
and/or provider availability related to Dual-Choice 2002 must contact
the plans directly. In doing so, your employees will receive the
most up-to-date information regarding providers or service areas.
PLEASE NOTE: In order to receive information pertinent
to the Group Health Insurance Programs administered by ETF, your
employees must identify themselves as a subscriber with the Wisconsin
Public Employers Group Health Insurance Program.
Please remind your employees who participate in the Group Health
Insurance plan they are responsible for providing their current
mailing addresses to their respective plans. The plans will take
employee address information over the telephone and report any changes
to ETF. Plans often tell us they are unable to contact current subscribers
due to incorrect addresses on file. Once mailing addresses are updated,
employees will receive provider information in a timely fashion.
This includes information related to student status, which will
enable ependents to continue their current health insurance.
Employers Application Processing Instructions for Dual-Choice
- Verify that the employee has completed the application in its
entirety. If an HMO is selected, there must be a Physician Name,
County that the physician provides services in and a Provider
Number, if known, entered on the application.
- Complete the Employer Portion of the application and provide
the following information on each Dual-Choice 2002 Health
- Employer Number (EIN)
- Name of Employer
- Payroll Representative Signature
- Telephone Number
- Group Number - The first digit is the number 7, followed
by the four-digit EIN.
- Enrollment Type 40 for Dual-Choice or 43 for Change from
Single to Family
- Employee Type
- Coverage Type Code
- Carrier Suffix
- Standard Plan Waiting Period if the Standard Plan is chosen
- Participant County Code - This county code represents the
county in which your employee resides
- Physician County Code - This county code represents the
county in which your employee receives primary care
- Date Received by Employer
- Date Employment Began - This box can be left blank, or insert
the date on which employment began with your entity.
- Monthly Employee Share
- Monthly Employer Share
- Event Date = January 1, 2002
- Prospective Date of Coverage = January 1, 2002
- Separate application for enrollment type 40 and enrollment type
- Send the Carrier Advanced Registration Copy of your Dual-Choice
applications on a weekly basis directly to the plans. All Advance
Carrier plies must be forwarded to the plans by November 9, 2001.
This approach will assist ETF in ensuring that your employees
receive their new subscriber cards prior to January 1, 2002.
- Send the ETF Copy of your Dual-Choice applications on a weekly
basis directly to ETF. All ETF plies must be forwarded to ETF
by ovember 9, 2001.
- Give the employee their copy and keep the Employer Copy for
your records. Submit the Carrier Copy with your monthly Additions
Report (ET-2610) to ETF by December 20, 2001.
Procedures for Withdrawing Dual-Choice Elections
Employees may rescind Dual-Choice elections by notifying their
employers in writing prior to December 31, 2001. 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.
Additional Dual-Choice Instructions
Specific Dual-Choice instructions are found in Chapter 4 of your
Local Health Insurance Employer Administration Manual (ET-1144)
- Refer to Subchapter 403 if you have an employee who is initially
eligible for coverage in November or December, or if you have
an employee who terminates employment in November or December.
- Refer to Subchapters 406 and 407 for the procedure to use if
you receive a Dual-Choice application after October 26, 2001.
Also note that late Dual-Choice material can be submitted to ETF
via fax at (608) 266-5801.
Contact the Employer Communication Center at (608) 264-7900 with
all questions related to health insurance eligibility and reporting,
including any questions related to this Employer Bulletin.