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Employers

Employer Bulletin

Local WRS Employers
Vol. 20, Local F
September 30, 2003

Health Insurance Dual Choice Information

Dual-Choice Enrollment Period Set for October 6-24, 2003

October 6-24, 2003 is the Dual-Choice Enrollment period for coverage effective January 1, 2004. 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 2004 It's Your Choice booklets will be supplied during the last week of September to all employers participating in the Wisconsin Public Employers' (Local) Group Health Insurance Program. Please distribute them to employees.

Individual letters identifying the lowest-cost qualified plan in your service area, and 2004 Health Plan Contacts (ET-1728), were sent to each employer's Department of Employee Trust Funds (DETF) contact person in a separate mailing. In November, you will receive both an Employer Bulletin containing additional instructions for Dual-Choice reporting and the 2004 monthly reporting forms. For reporting assistance, contact the Employer Communication Center at (608) 264-7900.

Dual-Choice Kick-off Meeting Reminder

The annual Dual-Choice kick-off meeting is set for Wednesday, October 1, 2003, 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. 20, No 7 dated May 23, 2003. Employer Bulletin Vol. 20, No 11 (dated August 8, 2003) provided employers with a registration form for the Kick-off Meeting. Room size is limited and you must pre-register for the Dual Choice Kick-off meeting. Copies of these Bulletins are available on the Employer Section of DETF's Internet site.

The Dual-Choice Kick-off meeting provides an opportunity for you to receive information from health plan representatives and from DETF employees regarding health plan changes that will take place effective January 1, 2004. Please call the Employer Communication Center at (608) 264-7900 with questions.

Education Teleconference Set

Employees, retirees and employers have an opportunity to participate in a statewide teleconference on the Dual-Choice health insurance program from 9:00 a.m. to 11:00 a.m. on Tuesday, October 14.

The Wisconsin Coalition of Annuitants, UW-Extension, UW Colleges, and Epsilon Sigma Phi will sponsor an educational teleconference through the UW-Extension Instructional Communications Systems WisLine Teleconference Service. This teleconference will feature Bill Kox, DETF Director of Health Benefits and Insurance Plans, on the topic of "How to Make the Most Out of Dual-Choice in Light of Program Changes." Time will be made available to answer questions on any topic related to the State Health Insurance Program.

To participate, contact the site in your county. See http://www.uwex.edu/ics/wisline/ for a list of Group Conferencing Sites, or call (608) 262-1598. If you are unable to travel to one of the sites, you may connect to the teleconference from any telephone by dialing 1-888-677-9189 and entering 0994# when prompted. A limited number of phone lines are available, so please arrange group sessions where possible.

Notable Changes to Administrative Provisions

Pharmacy Benefit Manager: In July 2003, the Group Insurance Board authorized DETF to contract with a Pharmacy Benefit Manager (PBM) to provide pharmacy benefits to all State of Wisconsin group health insurance participants. Beginning January 1, 2004, all participants will receive their pharmacy benefits from the PBM, Navitus Health Solutions. Participants will receive an identification card from Navitus, which is separate from the ID card they get from their health plans. For more information about the PBM, please visit the Department's Web site at http://etf.wi.gov/members/benefits_pbm.htm.

Student Status Letters: DETF annually requires participating health insurance plans to send out the full-time student/disabled dependent status letter. This mailing is scheduled to take place in late October, earlier than in past years. Plans are permitted to terminate dependents if no reply is received by December 1, 2003. The termination date for former dependents is the last date of eligibility, which in most cases is December 31, 2003.

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 DETF, as described above. Any employee or annuitant is eligible to pick any health plan as long as they utilize that plan's physicians.

Plans No Longer Available

Compcare Blue North (suffix .12). This change affects subscribers in Ashland, Burnett, Clark, Douglas, Forest, Iron, Langlade, Lincoln, Marathon, Oneida, Pepin, Pierce, Polk, Portage, Price, Sawyer, St. Croix, Taylor, Vilas, Wood, and Washburn Counties.

Current members of this plan must select a different plan for 2004. Compcare Blue North will notify current members of the change. If a new application is not made during Dual Choice, an application will have to be obtained for the Standard Plan.

New Plans Available

Compcare Blue Southeast (suffix .11). This change affects subscribers in Kenosha, Ozaukee, Racine, Walworth, Washington, and Waukesha Counties.

Plan Provider Network Changes

  • Unity-Community added dentists to Dodge, Iowa, and Jefferson counties, thus newly qualifying for State employees in these counties.
  • Touchpoint newly qualifies in Fond du Lac, Manitowoc, Marinette, and Sheboygan counties; and lost qulification in Winnebago County.
  • GHC Eau Claire newly qualifies in Rusk County. Atrium newly qualifies in Ashland, Dunn, and Jackson Counties.
  • Humana-Western newly qualifies in Trempeleau County.
  • Prevea newly qualifies in Oconto County.
  • Gundersen Lutheran will discontinue dental benefits for 2004.

The SMP replaces CompcareBlue North in many northern counties. Visit our Web site at to view a map with plans listed by county.

No Plan name changes

Notable Changes to Uniform Benefits for 2004

  • Effective January 1, 2004, a single Pharmacy Benefit Manager (PBM) will provide pharmacy benefits and services to all participants. Participants will receive an identification card from Navitus, which is separate from the ID card they get from their health plans. No separate enrollment application is required for the PBM.
  • For a complete list of uniform benefit changes, please visit our Web site.

General Information

Employees who want to continue participating in their current plan should do the following:

  • Verify that their current plans will be available in their areas for 2004.
  • Review the 2004 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 2004.
  • 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. on Friday, October 24, 2003.

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.

DETF will mail It's Your Choice booklets, complete with special application forms, directly to retirees and former employees (health insurance continuants). Employees who wish to change plans and who will retire effective January 1, 2004 or later, must complete applications as active employees. Changes in annuitant coverage will be handled by DETF when employees apply for annuitant benefits. However, employers with employer paid annuitants must provide these subscribers with the 2004 It's Your Choice booklets.

*Remind your employees to keep their 2004 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.
  • When calling Navitus or a health plan, employees must identify themselves as a State of Wisconsin Plan employee in order to receive information pertinent to the Group Health Insurance Programs administered by DETF.
  • Please remind your employees who participate in the Group Health Insurance plan that 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 DETF. Plans often report that 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, including information related to student status, which will enable dependents to continue their current health insurance.

Important Procedural Changes for the Submission of Health Insurance Applications

Why is DETF changing the Health Insurance Applications and Coverage Reports?

To ensure that the Pharmacy Benefit Manager (PBM) receives the most current information regarding employees enrolled in health insurance, the Department has changed the Group Health Insurance Application (ET-2301) and Group Health Insurance Application for Grad Students (ET2302) in addition to health insurance coverage reporting.

What are the changes to the health insurance application?

DETF revised several fields on the health insurance applications to comply with federal HIPAA regulations. A separate employer bulletin article further explaining the federal provisions will be distributed.

DETF changed the ply distribution order to:

  1. ETF Advance Copy
  2. Carrier Advance Copy
  3. Employer Copy
  4. ETF Coverage Report Copy
  5. Employee Copy

DETF will not distribute revised health insurance applications to employers along with the It's Your Choice booklets. You must order the revised health insurance applications immediately using one of the following methods:

  1. The Employer Section of DETF's Web site: http://etf.wi.gov
  2. DETF's self-service line 877-383-1888 (toll free) or 266-2323 (local)
  3. Filling out and returning the attached form to DETF.

What are the changes to the health application submission process?

  1. Send the ETF Advance Copy to DETF upon completion of the application.
  2. Send the Carrier Advance Copy to the appropriate health plan upon completion of the application.

    NOTE: For Dual-Choice, all carrier advance registration copies of the Dual-Choice applications must be sent to the plans by Friday, November 7, 2003.

  3. Retain the Employer Copy and give the Employee Copy to the employee.

What are the changes to the health insurance coverage report submission?

  1. The ETF Coverage Report Copy of the applications will be attached to the DETF copy of the Coverage Report for the appropriate month.
  2. No application plies will be attached to the carrier copy of the Coverage Report.
  3. Send both sets to DETF.

NOTE: This is an important change–the Carrier Copy of the application no longer exists.

When are these changes effective?

Employers must begin using the revised health insurance applications for:

  • 2004 Dual-Choice enrollment
  • All other enrollments with coverage begin date of January 1, 2004, or later and reported on the January 2004 (or later) Additions Report.

Destroy any remaining old Health Insurance Application forms after you submit the December 2003 Coverage Reports (due November 20).

Does this new health application process change the way I handle other health insurance forms?

No. You should continue to send copies of Health Insurance Information Change Reports (ET-2329), Group Health Insurance Transfer Reports (ET-1615), Group Health Insurance Cancellation Reports (ET-1616), and Medicare Eligibility Statements (ET-4307) directly to the health plans and to DETF upon completion of the forms as currently done. However, you may wish to include these forms when you mail the ETF Advance Copy to DETF and the Carrier Advance Copy to the health plans.

How should I submit the old applications for enrollments with coverage begin dates prior to January 1, 2004 (additions appearing on either the November or December coverage reports)?

This process will not change from the current process:

  1. Send the Carrier Advance Copy ply of the applications to the health plan upon completion of the application.
  2. Send the ETF Copy ply of the applications to DETF upon completion of the application.
  3. Attach the Carrier Copy ply of the applications to the carrier set of the November or December Coverage Reports.
  4. Retain Employer Copy ply and give Employee Copy ply to employee.

How should I submit the revised applications for enrollments with coverage begin dates prior to January 1, 2004 (additions appearing on either the November or December coverage reports)?

  1. Send the Carrier Advance Copy ply of the applications to the health plan upon completion of the application.
  2. Send the ETF Advance Copy ply of the applications to DETF upon completion of the application.
  3. Attach the ETF Coverage Report Copy ply of the applications to the carrier set of the November or December Coverage Reports.
  4. Retain Employer Copy ply and give Employee Copy ply to employee.

How should I submit the old applications for enrollments with coverage begin dates on or after January 1, 2004 (Dual-Choice and/or other additions appearing on the January or subsequent coverage reports)?

You must begin using the new applications for Dual-Choice and other enrollments with coverage begin dates of January 1, 2004 or later. However, if you use an old application in error for an enrollment beginning January 1, 2004 or later:

  1. Send the Carrier Advance Copy ply of the application to the health plan upon completion of the application.
  2. Send the ETF Copy ply of the application to DETF upon completion of the application.
  3. Attach the Carrier Copy ply of the application to DETF set of the January (or subsequent month) Coverage Reports.
  4. Retain Employer Copy ply and give Employee Copy ply to employee.

How should I submit the revised applications for enrollments with coverage begin dates on or after January 1, 2004 (Dual-Choice and/or other additions appearing on the January or subsequent coverage reports)?

  1. Send the ETF Advance Copy ply of the application to DETF upon completion of the application.
  2. Send the Carrier Advance Copy ply of the application to the appropriate health plan upon completion of the application.
  3. Attach the ETF Coverage Report Copy ply to the DETF copy of the Coverage Report for the appropriate month and send to DETF.
  4. Retain Employer Copy ply and give Employee Copy ply to employee.

Employers' Application Processing Instructions for Dual-Choice 2004

  1. You must 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 2004 Health Insurance Application:
    • Employer Identification 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 of January 1, 2004
    • Prospective Date of Coverage of January 1, 2004
  3. Each week send the Carrier Advance Copy ply of your Dual-Choice applications directly to the plans. All Advance Carrier plies must be forwarded to the plans by November 8, 2003. This approach will assist ETF in ensuring that your employees receive their new subscriber cards prior to January 1, 2004.
  4. Each week send the ETF Advance Copy ply of your Dual-Choice applications directly to DETF. All ETF Advance plies must be forwarded to DETF by November 7, 2003.

Procedures for Withdrawing Dual-Choice Elections

Employees may rescind Dual-Choice elections by notifying their employers in writing prior to December 31, 2003. 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 DETF as soon as you receive it.

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 followif you receive a Dual-Choice application after October 24, 2003. Also note that late Dual-Choice material can be submitted to DETF 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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