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
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
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
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
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
Notable Changes to Administrative Provisions
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
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
- 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)
Plans no longer available
No counties lost their SMP status.
No Plan name changes
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
- 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
- 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
- Douglas County – Humana-Western has switched from non-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
- Waukesha County – Dean has switched from 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.
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.
Other information about Uniform Benefits
All uniform benefits are included in the ETF Internet site
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 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
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 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.
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 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
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 2003 Health Insurance
- 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
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.
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.
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)
- 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.