Local WRS Health Employers
Vol. 21, Local J
September 27, 2004
Wisconsin Health Insurance Dual-Choice Information
Dual-Choice Enrollment Period for 2005 Coverage is October
October 11-29, 2004 is the Dual-Choice Enrollment period for coverage
effective January 1, 2005. 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 2005 It’s Your Choice booklets will be supplied to all
participating local government employers prior to October 11 for
distribution to employees. The Dual-Choice book will beavailable
on the Department of Employee Trust Funds’ (ETF) Web site
aby September 29. Additional information about the health insurance
program and other insurance programs offered to employees, annuitants
and continuants is also available at this site.
In November, you will receive an Employer Bulletin containing additional
Dual-Choice reporting instructions. ETF will send the monthly reporting
forms for calendar year 2005 during the second week of November
Dual-Choice Kick-off Meeting Reminder
The annual Dual-Choice Kick-off meeting is set for Wednesday, September
29, 2004, from 9:00 a.m. to 11:30 a.m. at the Quality Inn South,
4916 East Broadway, Madison, Wisconsin. No pre-registration is required.
Attendees may purchase coffee, other beverages and pastries at the
The Dual-Choice Kick-off meeting provides an opportunity for you
to receive information from health plans, pharmacy benefit manager
representatives, and ETF employees regarding health plan changes
set to take place effective January 1, 2005. Please call the Employer
Communication Center at (608) 264-7900 with questions.
No Dual-Choice Education Teleconference
ETF will not hold a Dual-Choice Education Teleconference this year.
Notable Plan and Program Changes
- Program Changes
ETF recently announced new health insurance program options available
for plan year 2005:
A preferred provider plan (PPP) administered by Blue Cross Blue
Shield of Wisconsin as an option within the classic fee-for-service
Standard Plan; and
A deductible option, offering premium rates averaging 10% below
An upcoming Employer Bulletin will provide detailed information
on enrolling in these new health insurance program offerings.
- Plans No Longer Available
Valley Health Plan will no longer be available as of
January 1, 2005. Subscribers enrolled in this plan must select
another plan for 2005. Valley Health Plan will notify current
subscribers of the change. If a new application is not submitted
during Dual Choice, an application will have to be obtained for
coverage under the Standard Plan.
State Maintenance Plan (SMP) will no longer be available in Buffalo,
Kewaunee, Pepin, Pierce and Rusk counties. Subscribers in these
counties must select another plan for 2005. Employees must live
in a SMP county to be eligible to enroll in SMP. If a new application
is not submitted during Dual- Choice, an application will have
to be obtained for coverage under the Standard Plan.
- New Plans Available
CompcareBlue Northwest (suffix .13) will be available as of January
1, 2005. CompcareBlue Northwest is located in Barron, Burnett,
Chippewa, Eau Claire, Pepin, Pierce, Polk, St. Croix, and Washburn
counties. This HMO offers Uniform Benefits.
- Plan Provider Network Changes
A number of plans have changed their service areas and some have
made significant changes. Please refer to the map on page A-3
and the Plan Descriptions in Section G of the 2005 It’s
Your Choice booklet. Subscribers should verify with their health
plan that their provider(s) will still be available to them in
2005. Note: The current health plan is required to provide subscribers
with a list of all plan providers that will not be available in
2005. Subscribers should contact their plan and request this information
if they have not received it by October 8, 2004.
- Plan Name Change
Touchpoint Health Plan has been acquired by UnitedHealthcare.
The new plan name is UnitedHealthcare of Wisconsin (UH) (suffix
remains .94). A subscriber currently enrolled in Touchpoint Health
Plan who fails to file an application during Dual Choice will
remain in UH. UnitedHealthcare will produce new identification
cards and its procedures for referrals and prior authorizations
Contact UH at their new phone number listed on the inside back
cover of the 2005 It’s Your Choice booklet with questions
- Notable Changes to Uniform Benefits for 2005
See page D-2 of the 2005 It’s Your Choice booklet for a
description of notable changes and clarifications.
- Changes to Dental Coverage
Network Health Plan is offering dental coverage in 2005.
Humana is extending the use of network provider discounts to dental
services not covered by their program. Should a subscriber have
non-covered services performed at a network provider, the subscriber
will pay a discounted amount.
See Section G, the Plan Description Pages of the 2005 It’s
Your Choice booklet for more information.
- Employee Payment in lieu of Coverage - Contract Language
The 2005 health insurance contract prohibits employers from making
payments to employees in lieu of coverage under the Group Health
Insurance Program; this has always been our practice, but the
contract now includes specific language to make it more clear
for employers. Employers agree to abide by the terms of the health
insurance contract by virtue of their resolution filed to join
our program. The prohibition is not intended to penalize a municipality
having such a provision in its collective bargaining or personnel
rules as long as it makes a good faith effort to remove it as
soon as practicable. Please keep in mind that employees continue
to have the option to decline coverage under the Group Health
Insurance Program but employers may not pay them to opt out.
- Information on Provider Quality
Leapfrog and CheckPoint: The Group Insurance Board supports
the goals of improving quality and safety of health care services.
The Leapfrog Group and CheckPoint gather information from Wisconsin
hospitals on efforts to adopt and enhance safety practices and
standards proven to reduce medical errors and save lives. The
Plan Descriptions in Section G of the 2005 It’s Your Choice
booklet note hospitals that reported information to the Leapfrog
Group and/or CheckPoint. Subscribers can visit the results on-line
at www.leapfroggroup.org and www.wicheckpoint.org. By providing
this information, ETF recognizes hospitals making improvements
in patient safety and quality.
Employees who want to continue participation in their current plans
should do the following:
- Verify that their current plans will be available in their
area for 2005.
- Verify that selected physicians, clinics, and/or hospitals will
still be available under their plans in 2005.
- Review changes in benefits by reading the “Notable Plan
and Program Changes” section, as well as the individual
plan descriptions found in the 2005 It’s Your Choice booklet.
- Call the health plan directly with specific benefit or provider
To change plans or coverage levels, employees must return
completed applications to their employers no later than 4:30 p.m.
on Friday, October 29, 2004.
Employees may select any alternate plan regardless of their county
of residence, but should consider whether the providers are within
a reasonable distance for medical care. SMP selection is based on
county of residence. 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 and former employees (health
insurance continuants). Employees who wish to change plans and who
will retire effective January 1, 2005, or later, must complete Dual-Choice
applications as active employees. Changes in annuitant coverage
will be handled by ETF when employees apply for annuitant benefits.
An employee eligible for the Group Health Insurance Program but
covered under a spouse’s plan, who loses eligibility for coverage
under that plan, has a special 30-day enrollment opportunity to
become insured under the Group Health Insurance Program without
waiting periods for pre-existing conditions. This same enrollment
opportunity exists for an employee covered under a spouse’s
plan in the event the spouse’s employer premium contribution
*Remind employees to retain the 2005 It’s Your Choice booklet
as a 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 indicate they do not wish to make a
change during Dual-Choice. Remind these employees that they
remain responsible for understanding the information contained
in the booklet and that it serves as the certificate of coverage
if they are enrolled in an alternate plan.
- Insured employees on temporary layoff or leave of absence.
Employees who let their health insurance lapse while on leave
of absence or temporary layoff which encompassed the entire
Dual-Choice enrollment period, should be advised that they are
eligible to make a Dual-Choice election within 30 days of returning
from the leave or layoff.
ETF does not distribute Health Insurance Applications (ET-2301)
to employers along with copies of the It’s Your Choice booklets.
To request applications, contact ETF Supply and Mail Services at
(608) 266-3302. Indicate your Employer name and Identification Number
(EIN), location, form name and number, and the quantity of forms
desired. In addition, note that your request is Dual-Choice related.
You can also request applications by completing the On-Line Forms
Order page found under “Employers” at http://etf.wi.gov.
Employees must contact the plans directly to request the most up-to-date
information regarding service area and/or provider availability
related to Dual-Choice 2005.
NOTE: When calling Navitus or a health plan, employees must identify
themselves as a State of Wisconsin plan subscriber in order to receive
information pertinent to the Group Health Insurance Program administered
Health plans often report they are unable to contact current subscribers
due to incorrect addresses on file. Please remind your employees
who participate in the Group Health Insurance Program that they
are responsible for providing address changes and revisions of other
relevant information to you via the Health Insurance Information
Change form (ET-2329). Employers are responsible for routing information
change forms to ETF and the health plans. Once mailing addresses
are updated, employees will receive provider information in a timely
fashion, including information related to the annual student status
verification process, which enables dependents to continue their
current health insurance.
Employer’s Application Processing Instructions for
- Verify that the employee has completed the application in its
entirety. If an HMO is selected, a Physician Name, the county
in which the physician provides services, and a Provider Number
(if known) must be entered on the application.
- Some plans will accept a clinic name in lieu of a physician.
Should a health plan not accept an application with a clinic name,
the employer is not responsible for obtaining this information.
The plan will contact the subscriber directly. Most plans require
the name of a primary care physician. It is the employee’s
responsibility to fill in this box on the application.
- Complete the Employer Portion of the application and provide
the following information on each Dual-Choice 2005 Health Insurance
- Employer Identification Number (EIN)
- Name of Employer
- Payroll Representative Signature
- Telephone Number
- Group Number
- Enrollment Type 40 for Dual-Choice; 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 agency
- Monthly Employee Share
- Monthly Employer Share
- Event Date of January 1, 2005
- Prospective Date of Coverage of January 1, 2005
Send the Advanced Carrier Registration Copy of Dual-Choice applications
directly to the plans on a weekly basis. All Advance Carrier plies
must be forwarded to the plans by November 12, 2004. This approach
will assist ETF in ensuring that your employees receive their new
subscriber cards prior to January 1, 2005.
Send the ETF Advance ply of Dual-Choice applications directly
to ETF on a weekly basis. All ETF Advance plies must be forwarded
to ETF by November 12, 2004.
More detailed instructions explaining Coverage Report processing
will be sent in November.
ADDRESS LIST FOR SENDING HEALTH INSURANCE APPLICATIONS
Most plans request that Dual-Choice applications be sent to their
address on the inside back cover of the It’s Your Choice book.
However, attached to this bulletin is a list of plans who have requested
employers mail applications to a different address to assist in
Procedures for Withdrawing Dual-Choice Elections
Employees may rescind 2005 Dual-Choice elections by notifying their
employers in writing prior to December 31, 2004. The written request
should be filed with the employee’s records. When you receive
a request to rescind, make four copies of your ply of the Dual-Choice
application initially submitted by the employee to select a change
and write “Rescind” across each copy. Forward one copy
to the current plan, one copy to the plan indicated as “Plan
Selected,” and one copy to ETF as soon as you receive the
request. Retain a copy for your records.
Additional Dual-Choice Instructions
Specific Dual-Choice instructions are found in Chapter 4 of your
Group Health Insurance Employer Administration Manual (ET-1118)
- Refer to Subchapter 403D if you have an employee who is initially
eligible for coverage in November or December, or who terminates
employment in November or December.
- Refer to Subchapters 406 and 407 for the procedure to follow
if you receive a Dual-Choice application after October 29, 2004.
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.
Plan Alternate Dual-Choice Application Mailing Addresses
Most health plans request that Dual-Choice applications be sent
to the plan address found on the inside back cover of the It’s
Your Choice book. However, to ensure timely processing, the following
health plans require Dual-Choice applications be sent to their alternate
address as listed below:
CompcareBlue—Aurora Family Network and SouthEast
CompcareBlue Enrollment Services
PO Box 262
Platteville, WI 53818
Attn: Maria Chumley - 9th Floor East
101 East Main Street
Louisville KY 40202
Network Health Plan:
Use address in It’s Your Choice book;
mark “Group Administration” on envelope.
Use address in It’s Your Choice book OR use
11830 Webb Chapel
Dallas TX 75234-2790
Fax (972) 232-8807
UnitedHealthcare (formerly, Touchpoint):
Attn: Andrea Darling
PO Box 507
Appleton WI 54912-0507