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Employers

Employer Bulletin

Local Health Employers
Vol. 22, Local M
October 19, 2005

  • Plans Mail Annual Dependent Status Letters and Questionnaires
  • Pharmacy Benefit Manager (PBM) ID Card Reminder
  • It’s Your Choice Booklet Corrections/Updates

Annual Student/Disabled Dependent Status Letters

The Department of Employee Trust Funds (ETF) requires that participating health plans annually send the attached letter and questionnaire to subscribers with dependents age 19 or older. This year, participating health plans will begin mailing questionnaires to subscribers the week of October 24. The deadline to return them to the health plan is December 9, 2005. Health plans must receive questionnaires by this date in order to ensure that coverage will continue on January 1, 2006. If Health Plans receive the Student/Disabled Dependent Status questionnaire later than December 9, the dependent’s health insurance coverage may end as of December 31, 2005.

Note: Health plans are not allowed to accept verbal responses to the student/disabled dependent status questionnaire.

Subscribers switching health plans during the 2006 Dual-Choice enrollment period must complete and return the dependent status questionnaire to the health plan that initiated the letter, not the health plan selected for 2006. ETF will notify the new health plan (the subscriber’s Dual-Choice selection) of any dependent status changes based on the questionnaire. Subscribers covered by CompcareBlue Northeast in 2005 must return the student/disabled dependent status questionnaires to CompcareBlue Northeast even though the health plan will no longer be available in 2006.

Health Plans will notify ETF of terminated dependents on January 3, 2006. Subscribers’ failure to complete and return the student/disabled dependent status questionnaire may result in denied/delayed claims and prescription drug benefits for dependents.

ETF will notify employers of terminated dependents the week of January 9, 2006. Employers will receive a report, compiled from the data submitted by the health plans, notifying them of their subscribers’ terminated dependents.

For changes from family to single coverage resulting from a change in student/disabled dependent status, employers must:

  • Request a Health Insurance Application (ET-2301) from any subscriber changing from family to single coverage, and
  • Issue a Continuation/Conversion Notice (ET-2311) to previously covered dependent(s).

In the event family coverage remains in force following removal of a student/disabled dependent from coverage, employers must:

  • Request a completed Health Insurance Information Change form (ET-2329) deleting the dependent from the existing family contract, and
  • Issue a Continuation/Conversion Notice (ET-2311) to previously covered dependent(s).

Dependent Reinstatement

In the event a dependent is terminated due to non-response to the health plan’s questionnaire, coverage can be reinstated back to the date of termination by submission of one type of documentation of student status and a Health Insurance Information Change form (ET-2329) to ETF. Examples of types of documentation include:

  • Current class schedule
  • Completed Student Status Letter
  • Letter from the educational institution indicating the dependent is a full-time student for the current semester
  • Copy of a payment receipt from the educational institution for the current semester. The receipt must indicate the total class credits taken.

Reminder: Pharmacy Benefit Manager (Navitus) ID Cards

The program’s pharmacy benefit manager (PBM), Navitus Health Solutions, will send new identification (ID) cards to subscribers only when one or more of the following information changes occur:

  • New health plan selected, including selections made during Dual-Choice
  • Dependent(s) added or deleted
  • Group number change
  • Name change

Subscribers without any of the changes noted above should continue to use their existing Navitus ID card. Subscribers can request additional copies of their ID card by contacting Navitus customer service at:

Navitus Health Solutions
5 Innovation Court
Appleton, WI 54912
Phone: (toll free) 1-866-333-2757
www.navitushealth.com

Please contact the Employer Communication Center at (608) 264-7900 with questions regarding the Student/Disabled Dependent Status Questionnaire or the PBM ID cards.

It’s Your Choice Booklet Corrections/Updates

Please note the following corrections/updates to the 2006 It’s Your Choice booklets. ETF strives to provide the most complete and accurate information possible so that subscribers can make informed health insurance coverage decisions. We apologize for any inconvenience these changes may cause.

Subscribers wanting additional information regarding benefits and participating providers should contact the health plan or PBM. (For health plan contact information go to plan addresses.)

Corrections to all It’s Your Choice booklets:

  • On page D-2, Changes to Uniform Benefits, the table states that the 2005 Emergency Room copay is $50. It is currently $40 (but will increase to $60 in 2006).
  • The “Hospitals in County” list on the Plan Description Page for CompcareBlue Southeast (Section G), Kenosha County, should include St. Catherine’s Hospital and Kenosha Hospital. They are in-network providers.
  • The Plan Description Page for Humana Eastern (Section G), dental benefits information, lists an incorrect Internet site address. It should read http://www.humanadental.com. Also, some members are having trouble connecting to Humana Eastern and Humana Western’s online provider directory. You may also use http://www.humana.com to locate in-network providers.
  • The Plan Description Page for UnitedHealthCare Southeast (Section G) should list Racine County providers; this health plan is qualified in this county.
  • On the How to Contact the Health Plans page (inside back cover), the WPS Prevea Health Plan Internet mail address should read http://wpspreveahealthplan.com.

Corrections to the Wisconsin Public Employers’ booklet (ET-2128) only:

  • See the grid that explains map codes on page A-2. CompcareBlue Southeast should be noted as CS (not NS) and Dean Health Plan should be noted as D (not C). The map on page A-3 is correct.
  • Following Section D, Uniform Benefits, there are five blank sheets. These pages, between D-48 and E-1, were intentionally left blank. No material is missing from the booklet.
  • Page G-50 is a duplicate of page G-44. Please disregard.

UnitedHealthcare Provider Directory

  • UnitedHealthcare printed one combined provider directory for both UnitedHealthcare SE and UnitedHealthcare NE networks. ETF requires a separate provider directory for each plan. UnitedHealthcare is working to publish new directories as soon as possible. Subscribers, as well as employers who received a UnititedHealthcare directory at the Dual-Choice Kick Off meeting on October 6, may request a corrected directory by calling UnitedHealthcare Customer Service at 1-800-357-0974.

GHC Eau Claire Clinics

  • GHC Eau Claire recently added several clinics in northwestern Wisconsin. For more information, go to the ETF internet site and click on “SMP FAQs for Northwest Wisconsin.”

Subscribers with questions regarding applications, eligibility, enrollment, and general information should contact ETF (toll-free) at 1-877-533-5020 or (608) 266-3285 (local Madison).

Employers with questions regarding applications, eligibility, enrollment, and general information should contact the Employer Communication Center at (608) 264-7900.