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Employers

Employer Bulletin

Local WRS Employers
Vol. 19, Local E
September 18, 2002

Health Insurance Dual-Choice Information

Location Change for Dual-Choice Kick-off Meeting

Quality Inn South
4916 East Broadway
Madison, WI 53716
(608) 222-5501
Date: Tuesday, October 1, 2002
Time: 9:00 a.m. – 11:30 a.m

Due to a major remodeling effort underway at the Mendota Mental Health Conference Center, the location for the annual Dual-Choice Kick-off meeting has been changed. Please join us at the Quality Inn South.

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 effective January 1, 2003. Please call the Employer Communication Center at (608) 264-7900 with questions.

Dual-Choice Enrollment Period for 2003 is set for October 7-25, 2002

October 7-25, 2002 is the Dual-Choice Enrollment period for coverage effective January 1, 2003. Dual-Choice provides an opportunity for insured subscribers (active employees, annuitants, and former employees who have continued their coverage) to change health insurance plans and/or change from single to family coverage without a waiting period for pre-existing conditions. The 2003 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 during the last week of September.

Individual letters identifying the lowest-cost qualified plan in your service area and 2003 Health Plan Contacts (ET-1728) were mailed to each employer's ETF contact person under separate cover. 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 2003 monthly reporting forms during the second week of November 2002.

Note: Corrections to the 2003 It's Your Choice booklet (ET-2128 rev 10/02)

Notable Plan and Program Changes, page i, under Changes to Uniform Benefits, states: "Please Note: Active state employees may put money into the ERA program to cover out-of-pocket medical costs by using pre-tax dollars." This message is for state employees only and should not have appeared in the It's Your Choice book (ET-2128).

Plan description pages for Health Tradition, Medical Associates, MercyCare, Network, Prevea, and Touchpoint erroneously state that the prescription drug dispensing policy provides up to a 34-day supply per co-pay. The prescription drug dispensing policy outlined in Uniform Benefits for 2003 provides up to a 30-day supply per co-pay.

We regret the errors and ask that employers notify their employees of these changes via e-mail, employer newsletters, bulletin board postings and/or "insert" pages for the Dual Choice Book.

Teleconference through UW-Extension's WisLine Web and Teleconferencing Service

ETF is sponsoring a teleconference through the UW-Extension's WisLine Web and Teleconferencing Service. The conference is scheduled for Tuesday, October 15, from 9:00 a.m. – 10:30 a.m. and will address questions about the Dual-Choice Enrollment period. To obtain information concerning the WisLine Web and Teleconferencing site in your area, you may check the web site at http://www.uwex.edu/payroll/DCSites.html, or you may contact the UW-Extension Instructional Communication Service (ICS) at 1-608-262-7590, or you may visit our Internet site at etf.wi.gov.

Notable Changes to Administrative Provisions
  • 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) was modified to include this change. Employer Bulletin Vol. 19, No. 13, dated July 15, 2002 provides further instructions for handling this provision.

    EXAMPLE: A dependent ceases to be a full-time student as of 12/31/2002. 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 may select any plan offered in Milwaukee County at the time COBRA/Continuation is elected.

  • Late Dual-Choice Network Change – If a plan offers more than one network (eg. 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 a subscriber after the October 25, Dual-Choice deadline, process the application with the later of an effective date of January 1, 2003 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 upon request.

Plan Information

The state map, found on page A-3 of the It's Your Choice booklet, reflects both qualified and non-qualified plans in each county. "Qualified" means the plan meets minimum provider requirements to be included in the low cost plan formula as determined by ETF, as described above. Remember: any employee or annuitant is eligible to pick any health plan as long as they utilize that plan's physicians.

  1. Plans newly available in these Counties
    • SMP is a new option in Kewaunee and Lincoln Counties, as there are no qualified Health Maintenance Organization (HMO) in these counties.
    • Columbia County – Network-Fox Valley (non-qualifying)
    • Florence County – Humana-Western (non-qualifying)
    • Green County – Dean Health Plan (qualifying)
    • Iron County – Humana-Western (non-qualifying)
    • Jefferson County – Humana-Eastern (qualifying)
    • Juneau County – Dean Health Plan and Health Tradition (both non-qualifying)
    • Marinette County – Humana-Western and Touchpoint Health Plan (both non-qualifying)
    • Oconto County – CompcareBlue Northeast (qualifying)
    • Richland County – Physicians Plus-South Central (qualifying)
    • Rusk County – GHC-Eau Claire (qualifying)
    • Sawyer County – Humana-Western (non-qualifying)
    • Vernon County – Dean Health Plan (non-qualifying)
  2. Plans no longer available
    • Security Health Plan (suffix .71). This change affects subscribers in Barron, Chippewa, Clark, Dunn, Eau Claire, Forest Iron, Jackson, Langlade, Lincoln, Marathon, Oneida, Portage, Price, Rusk, Sawyer, Shawano, Taylor, Trempealeau, Vilas, Washburn, Waupaca, Waushara and Wood Counties.

      Current members of this plan must select another plan for 2003. Security Health Plan will notify current members of the change. If an application is not made, an application will have to be obtained for the Standard Plan.

  3. No counties lost their SMP status.
  4. No Plan name changes
  5. Plan Provider Network Changes
    • Ashland County – Atrium Health Plan has switched from non-qualifying to qualifying.
    • Barron County – Humana-Western has switched from non-qualifying to qualifying. Valley Health Plan has switched from qualifying to non-qualifying.
    • Bayfield County – Humana-Western is no longer available.
    • Brown County – Network-Fox Valley is no longer available.
    • Burnett County – Humana-Western has switched from non-qualifying to qualifying.
    • Chippewa County – Humana-Western has switched from non-qualifying to qualifying.
    • Columbia County – Physicians Plus-South Central has switched from non-qualifying to qualifying.
    • Crawford County – Health Tradition has switched from qualifying to non-qualifying.
    • Dodge County – Humana-Eastern has switched from non-qualifying to qualifying.
    • Douglas County – Humana-Western has switched from non-qualifying to qualifying.
    • Dunn County – Valley Health Plan has switched from qualifying to non-qualifying.
    • Eau Claire County – Atrium Health Plan has switched from non-qualifying to qualifying.
    • Fond du Lac County – Humana-Eastern and Network-Fox Valley have switched from non-qualifying to qualifying. Touchpoint Health Plan has switched from qualifying to non-qualifying.
    • Grant County – Gunderson Lutheran has switched from non-qualifying to qualifying.
    • Jackson County – Valley Health Plan is no longer available.
    • Kewaunee County – Touchpoint Health Plan has switched from qualifying to non-qualifying.
    • Manitowoc County – Humana-Eastern has switched from qualifying to non-qualifying.
    • Polk County – CompcareBlue-North is still available but has switched from qualifying to a non-qualifying plan.
    • Price County – GHC-Eau Claire is no longer available.
    • St. Croix County – GHC-Eau Claire is no longer available. CompcareBlue-North and Valley Health Plan are still available but have switched from qualifying to non-qualifying plans.
    • Taylor County – CompcareBlue North has switched from non-qualifying to qualifying.
    • Vernon County- Unity Community has switched from non-qualifying to qualifying.
    • Waukesha County – Dean has switched from qualifying to non-qualifying.
    • 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 2003. Subscribers should contact their plans if they have not received this information by October 11.
  6. Notable Changes to the Uniform Benefits for 2003
    • The Annual prescription drug out-of-pocket maximum will be $300 per individual and $600 for a family.
    • The prescription drug card co-payment for brand name drugs only will be $17.25 per prescription.
    • The maximum prescription drug supply per co-pay will decrease from 34 days to 30 per prescription.
    • Cochlear implants will be covered at 80% subject to medical necessity criteria as determined by the Plan.
    • The lifetime maximum per participant is increasing from $1,000,000 to $2,000,000.
    • Ambulance service will be paid at 100% as medically necessary in 2003. This is increased from 100% coverage up to $300 ground, $1,000 air transport.
    • Orthoptic (eye training exercises) will be covered for up to two sessions as medically necessary.
  7. Other information about Uniform Benefits

    All uniform benefits are included in the ETF Internet site at etf.wi.gov.

General Information

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 for 2003.
  • Review the 2003 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 2003.
  • 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 questions.

Employees must return completed applications to change plans to their employers no later than 4:30 p.m., Friday, October 25, 2002.

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

The employer premium for insured employees appointed to work 1,044 hours per year or more can only be between 50% and 105% of the lowest cost qualified plan. For insured part-time employees appointed to work less than 1,044 hours per year, the employer premium cannot be less than 25% of the lowest cost qualified plan. For a retiree, surviving dependent or an eligible employee on leave of absence or layoff, the employer contribution is optional. These rules are provided for in Wis. Admin. Code Chapter ETF 40.10 and must be followed.

ETF will mail It's Your Choice booklets, complete with special application forms, directly to most retirees (WRS annuitants) and all former employees or dependents on COBRA continuation (continuants). If you have employees that want to change plans and who will retire effective January 1, 2003 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 must provide these subscribers with the 2003 It's Your Choice booklets.

NOTE: Forward all "carrier advance registration" copies of the Dual-Choice applications to the plans by Friday, November 8, 2002. Please make sure that the employee selects a primary care physician and that the employer portion of the application is completed.

*Remind employees to keep their 2003 It's Your Choice booklet as reference for the entire plan year.

Booklet Distribution

It's Your Choice booklets must be distributed in a timely manner to all insured employees including:

  1. 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.
  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 continuants and WRS annuitants who pay premium by annuity deduction or directly to the plan 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 2003 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 dependents to continue their current health insurance.

Employers' Application Processing Instructions for Dual-Choice 2003

  1. 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.
  2. Complete the Employer Portion of the application and provide the following information on each Dual-Choice 2003 Health Insurance Application:
    • 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, 2003
    • Prospective Date of Coverage = January 1, 2003
  3. 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 8, 2002. This approach will assist ETF in ensuring that your employees receive their new subscriber cards prior to January 1, 2003.
  4. 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 November 8, 2002.
  5. 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, 2002.

Procedures for Withdrawing Dual-Choice Elections

Employees may rescind Dual-Choice elections by notifying their employers in writing prior to December 31, 2002. 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) revised 6/97.

  • 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 25, 2002. 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.

 

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