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Employers

Employer Bulletin

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 11-29, 2004

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 2004.

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 site.

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

  1. 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 traditional rates.

    An upcoming Employer Bulletin will provide detailed information on enrolling in these new health insurance program offerings.
  2. 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.
  3. 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.
  4. 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.
  5. 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 will change.

    Contact UH at their new phone number listed on the inside back cover of the 2005 It’s Your Choice booklet with questions or concerns.
  6. 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.
  7. 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.
  8. 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.
  9. 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.

General Information

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 questions.

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 ends.

*Remind employees to retain the 2005 It’s Your Choice booklet as a 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 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.
    2. 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 by ETF.

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 Dual-Choice 2005

  1. 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.
  2. 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.
  3. Complete the Employer Portion of the application and provide the following information on each Dual-Choice 2005 Health Insurance Application:
    • 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 TO PLANS

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 timely processing.

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) revised 1/97.

  • 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 only:
CompcareBlue Enrollment Services
PO Box 262
Platteville, WI 53818

Humana:
Attn: Maria Chumley - 9th Floor East
Humana Enrollment
101 East Main Street
Louisville KY 40202

Network Health Plan:
Use address in It’s Your Choice book;
mark “Group Administration” on envelope.

Physicians Plus:
Use address in It’s Your Choice book OR use
Physicians Plus
11830 Webb Chapel
Dallas TX 75234-2790
Fax (972) 232-8807

UnitedHealthcare (formerly, Touchpoint):
Attn: Andrea Darling
UnitedHealthcare
PO Box 507
Appleton WI 54912-0507

 

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