Local WRS Employers
Vol. 22, Local L
September 20, 2005
Health Insurance Dual-Choice Information
Dual-Choice Enrollment Period is October 10-28, 2005
October 10-28, 2005 is the Dual-Choice Enrollment period for coverage
effective January 1, 2006. 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.
During the week of October 3, the 2006 It’s Your Choice booklets
(ET-2128 Rev 10/2005) will be supplied to all participating local
government employers for distribution to employees.
NOTE: Local employers enrolled in the Traditional HMO-Classic Standard
Plan should reference the rate sheet attached to this bulletin.
Employers enrolled in one of the other health insurance program
options will receive a separate addendum that must be provided to
employees along with the It’s Your Choice booklet. These other
health insurance program options are:
- Traditional HMO Option paired with the Standard Preferred Provider
Plan (PPP) (ET-2157)
- Deductible HMO Option paired with the Deductible Standard Plan
- Deductible HMO Option paired with the Deductible Standard PPP
Refer to Employer Bulletin, Vol. 22,
Local J, dated August 16, 2005, for additional information on
these WPE Group Health Insurance Program options.
The Dual-Choice booklet will also be available on the Department
of Employee Trust Funds (ETF) Internet site, at http://etf.wi.gov,
the week of October 3. Additional information about the Group Health
Insurance Program and other insurance programs administered by ETF
is also available on this site, including the addendum.
In November, you will receive an Employer Bulletin containing additional
Dual-Choice reporting instructions. ETF will send the monthly health
insurance reporting forms for calendar year 2006 during the second
week of November 2005.
Dual-Choice Kick-off Meeting Reminder
The annual Dual-Choice Kick-off meeting is set for Thursday, October
6, 2005, from 9:00 a.m. to 11:30 a.m. at the Rodeway Inn (former
Quality Inn South), 4916 East Broadway, Madison, Wisconsin. Pre-registration
is not required. Attendees may purchase coffee, other beverages,
and pastries at the site.
The Dual-Choice Kick-off meeting provides an opportunity to receive
information from health plans, pharmacy benefit manager representatives,
and ETF employees regarding health insurance program changes set
to take place effective January 1, 2006. Please call the Employer
Communication Center at (608) 264-7900 with questions.
No Dual-Choice Education Teleconference
The Wisconsin Coalition of Annuitants, UW-Extension and ETF will
not hold a Dual-Choice Education Teleconference this year.
Notable Plan and Program Changes
1. Medicare Part D Information
Information regarding this coverage is available in the 2006
It’s Your Choice booklet, under the Questions and Answers,
in Section C, numbers 64 and 65. The Certificate of Creditable
Coverage appears in Section B. ETF will mail additional information
to employers and Medicare participants in the coming weeks.
2. Plans No Longer Available
- CompcareBlue Northeast (suffix .14) will no
longer be available as of January 1, 2006. Subscribers enrolled
in this health plan must select another health plan for 2006.
CompcareBlue Northeast will notify current subscribers of the
change. In the event a subscriber fails to submit a new application
during Dual-Choice, an application will have to be obtained for
coverage under the Standard Plan.
- Atrium Health Plan has merged with CompcareBlue
Northwest. The acquisition was announced after portions of the
2006 It’s Your Choice booklet were printed. Please disregard
references in the booklet to Atrium Health Plan. CompcareBlue
Northwest will produce new identification cards and mail out information
regarding referral and prior authorization procedures to Atrium
Health Plan members prior to Dual Choice. Atrium subscribers who
do not file an application during Dual Choice will automatically
be enrolled in CompcareBlue Northwest. Subscribers with questions
or concerns should contact CompcareBlue Northwest at the phone
number listed on the inside back cover of the 2006 It’s
Your Choice booklet.
3. New Plans Available
WPS Patient Choice Plan 1 (suffix .81) and WPS Patient
Choice Plan 2 (suffix .82) will be available as of January
1, 2006. WPS Patient Choice Plans are located in Milwaukee, Ozaukee,
Washington and Waukesha counties and insured by WPS Health Insurance
(WPS). WPS Patient Choice Plan 2 is also available in Racine county.
These Preferred Provider Plans (PPP) have different networks and
offer Uniform Benefits for in-network services. For more information,
contact WPS at the telephone number and address listed on the
inside back cover of the 2006 It’s Your Choice booklet.
4. Plan Name Change
Prevea Health Plan has been acquired by WPS.
The new health plan name is WPS Prevea Health Plan (suffix remains
.47). Current Prevea subscribers who wish to continue under WPS
Prevea Health Plan do not need to file a Dual-Choice application.
WPS Prevea will produce new identification cards in the future.
However, current Prevea ID cards will be accepted by WPS Prevea
providers. WPS Prevea will mail out information regarding provider
network changes to current members prior to Dual Choice. For more
information, contact WPS Prevea at the telephone number and address
listed on the inside back cover of the 2006 It’s Your Choice
5. Plan Provider Network Changes
6. Change of Administrator for Standard Plan and SMP
The administration of these plans is changing to WPS Health Insurance
(WPS) from Blue Cross & Blue Shield of Wisconsin (BCBSWI). Plan
members will receive information this fall and early winter from:
- WPS—Explanatory literature and later, new ID cards
- BCBSWI—Request for information on status of student
or disabled dependent to members with dependents over age 19.
Employees should return this information to BCBSWI.
7. Notable Changes to Uniform Benefits for 2006
See page D-2 of the 2006 It’s Your Choice booklet for a
description of notable changes and clarifications.
8. Changes to Dental Coverage
Due to the acquisition of Atrium by CompcareBlue Northwest, members
of Atrium who opt to roll into CompcareBlue Northwest will no
longer have dental coverage, as CompcareBlue Northwest does not
offer such coverage.
See section G, Plan Description Pages of the 2006 It’s
Your Choice booklet for more information or contact the health
9. Employee Payment in Lieu of Coverage - Contract Language
The health insurance contract prohibits employers from making
payments to employees in lieu of coverage under the Group Health
Insurance Program. 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
10. Information on Provider Quality
Leapfrog, CheckPoint and Healthclick Wisconsin:
The Group Insurance Board supports the goals of improving the
quality and safety of health care services. The Leapfrog Group,
CheckPoint and Healthclick Wisconsin gather information from Wisconsin
hospitals on their efforts to adopt and enhance safety practices
and standards proven to reduce medical errors and save lives.
The Questions and Answers in Section C and Plan Descriptions in
Section G of the 2006 It’s Your Choice booklet have additional
information about hospitals that reported information to these
organizations. Subscribers can visit the results on-line at www.leapfroggroup.org,
By providing this information, ETF recognizes hospitals making
improvements in patient safety and quality.
General Dual Choice Information
Employees wishing to continue participation in their current health
plans should do the following:
- Verify that their current health plans will be available in
their area for 2006.
- Verify that selected physicians, clinics, and/or hospitals
will still be available under their health plans in 2006.
- Review changes in benefits by reading the “Notable Plan
and Program Changes” section, as well as the individual
health plan descriptions, found in the 2006 It’s Your Choice
- Call the health plan directly with specific benefit or provider
To change health plans or coverage levels, employees must
return completed health insurance applications to their employers
no later than 4:30 p.m. on Friday, October 28, 2005.
Employees may select any alternate health plan (i.e., HMO) regardless
of their county of residence, but should consider whether the providers
are within a reasonable distance for medical care. The 2006 It’s
Your Choice booklet identifies geographic areas covered by each
ETF mails It’s Your Choice booklets, complete with special
application forms, directly to retirees and former employees who
have continued their health insurance coverage. Employees who wish
to change health plans and who will retire effective January 1,
2006, or later, must complete their Dual-Choice applications as
active employees. Changes in annuitant coverage will be handled
by ETF when the employee applies for annuitant benefits.
An employee eligible for the State 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 State 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
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. Please remind
these employees that they remain responsible for understanding
the information contained in the It’s Your Choice booklet
and that the booklet serves as their certificate of coverage
if enrolled in an alternate health plan (HMO).
- Insured employees on temporary layoff or leave of
absence. Employees who allowed health insurance coverage
to lapse while on a leave of absence or a temporary layoff that
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.
Note: Remind employees to keep the 2006 It’s
Your Choice booklet as a reference for the entire plan year.
ETF does not distribute Health Insurance Applications (ET-2301)
to employers along with copies of the It’s Your Choice booklets.
To request applications:
- Complete the Online Forms Order page found under “Employers”
at http://etf.wi.gov. OR
- 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.
Employees must contact plans directly to request the most up-to-date
information regarding service area and/or provider availability
related to Dual-Choice 2006.
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 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 who remain eligible
in 2006 to continue their current health insurance.
Employer’s Application Processing Instructions for
- Verify that the employee has completed the application in its
entirety. If a Health Maintenance Organization (HMO) is selected,
a physician/clinic name, and the county in which the physician
provides services must be entered on the application.
Some health 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 health plan will contact the subscriber directly. Most health
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 2006 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
- Employee Type
- Coverage Type Code
- Carrier Suffix
- 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 – Leave Blank
- Prospective Date of Coverage of January 1, 2006
- Send the Advanced Carrier Registration Copy of Dual-Choice applications
directly to the health plans on a weekly basis. All Advanced Carrier
plies must be forwarded to the health plans by November 11, 2005.
This approach will assist ETF in ensuring that your employees
receive their new subscriber cards prior to January 1, 2006.
- 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 11, 2005.
More detailed instructions explaining Coverage Report processing
will be mailed in November.
Procedures for Withdrawing Dual-Choice Elections
Employees may rescind 2006 Dual-Choice elections by notifying their
employers in writing prior to December 31, 2005. 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 health plan, one copy to the health 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.
- Refer to Subchapter 401D if you have an employee initially eligible
for coverage in November or December 2005, or who terminates employment
in November or December 2005.
- Refer to Subchapters 404 and 405 for the procedure to follow
if you receive a Dual-Choice application after October 28, 2005.
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 respective plan address listed on the inside back cover of
the 2006 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:
Group Health Cooperative-South Central:
Attn: GHC Enrollment Department
1265 John Q. Hammons Dr.
PO Box 44971
Madison WI 53744-4971
Attn: Maria Chumley - 6th Floor
101 East Main Street
Louisville KY 40202
Network Health Plan:
Use address in It’s Your Choice book;
mark “Group Administration” on envelope.