Employer Bulletin

Local WRS Employers
Vol. 22, Local O
December 1, 2005

2006 Wisconsin Public Employers Group Health Insurance Reporting Forms: Notice of Change; Dual-Choice Due Dates; Alternate Report Requests; Reporting and Assembly of 2006 Health Reports

2006 Wisconsin Public Employers (WPE) Group Health Insurance Reporting Forms

Notice of change in report distribution:

Enclosed with this bulletin:

• One copy of each of the following 2006 WPE Group Health Insurance reporting forms and documents. In the past, multiple copies were provided.
• Mailing labels for sending reports to the Department of Employee Trust Funds.

For monthly reporting during 2006, please:

1. Photocopy the forms, OR
2. View and print the following forms from our Internet site, http://etf.wi.gov. Make sure you print the forms for the option in which you are enrolled:
   • WPE Health Insurance Summary – 2006 and WPE 2006 Monthly Coverage Report (See below for form numbers and descriptions)
   • Monthly Additions Report (ET-2610) Rev. 11/2005
   • Monthly Deletions Report (ET-2612) Rev. 11/2005
   • Monthly Changes Report (ET-2614) Rev. 11/2005

In 2005, the Department of Employee Trust Funds (ETF) revised the WPE Health Insurance Summary and the WPE Monthly Coverage Report to reflect new health insurance program options available to local employers. The attached 2006 forms continue to display the Program Option Code and Surcharge Code in the title of the reporting forms and include the 2006 premiums. Premiums for each health plan differ depending on the program option. You must use the reporting forms corresponding to the program option in which you are enrolled. Due to the complexity of the changes in reporting, please compare the forms provided to the list of forms below to verify that the correct forms have been included in this mailing.

Note: You remain in the same program option as last year until you submit a resolution electing an alternative program option and that resolution is approved by ETF.

The list below identifies the 2006 reporting forms (revised 10/2005) based on all of the program options available in 2006. Please use only the forms for the option in which you are enrolled:

Traditional HMO paired with the Classic Standard Plan (Current Program Option for most employers)

1. WPE Traditional HMO/Classic Standard Plan PGM OPT 02 & SRCHG S01 Health Insurance Summary – 2006 (ET-1631)
2. WPE Traditional HMO/Classic Standard Plan PGM OPT 02 & SRCHG S01 2006 Monthly Coverage Report (ET-1630)
3. WPE Annuitants Traditional HMO/Classic Standard Plan PGM OPT 02 & SRCHG S01 Health Insurance Summary – 2006 (ET-1655)
4. WPE Annuitants Traditional HMO/Classic Standard Plan PGM OPT P02 & SRCHG S01 2006 Monthly Coverage Report (ET-1657)

Traditional HMO paired with Standard Preferred Provider Plan (PPP)

1. WPE Traditional HMO/Standard PPP PGM OPT P03 & SRCHG S01 Health Insurance Summary – 2006 (ET-1652)
2. WPE Traditional HMO/Standard PPP PGM OPT P03 & SRCHG S01 2006 Monthly Coverage Report (ET-1643)
3. WPE Annuitants Traditional HMO/Standard PPP PGM OPT P03 & SRCHG S01 Health Insurance Summary – 2006 (ET-1644)
4. WPE Annuitants Traditional HMO/Standard PPP PGM OPT P03 & SRCHG S01 2006 Monthly Coverage Report (ET-1658)

Deductible HMO paired with Deductible Standard Plan

1. WPE Deductible HMO/Deductible Standard Plan PGM OPT P04 & SRCHG S01 Health Insurance Summary – 2006 (ET-1649)
2. WPE Deductible HMO/Deductible Standard Plan PGM OPT P04 & SRCHG S01 2006 Monthly Coverage Report (ET-1647)
3. WPE Annuitants Deductible HMO/Deductible Standard Plan PGM OPT P04 & SRCHG S01 Health Insurance Summary – 2006 (ET-1653)
4. WPE Annuitants Deductible HMO/Deductible Standard Plan PGM OPT P04 & SRCHG S01 2006 Monthly Coverage Report (ET-1645)

Deductible HMO paired with Deductible Standard PPP

1. WPE Deductible HMO/Deductible Standard PPP PGM OPT P05 & SRCHG S01 Health Insurance Summary – 2006 (ET-1650)
2. WPE Deductible HMO/Deductible Standard PPP PGM OPT P05 & SRCHG S01 2006 Monthly Coverage Report (ET-1648)
3. WPE Annuitants Deductible HMO/Deductible Standard PPP PGM OPT P05 & SRCHG S01 Health Insurance Summary – 2006 (ET-1654)
4. WPE Annuitants Deductible HMO/Deductible Standard PPP PGM OPT P05 & SRCHG S01 2006 Monthly Coverage Report (ET-1646)

It is critical that you use only the 2006 Summary and Monthly coverage reports when reporting for 2006. In addition to the 2006 monthly reports, please use the most recently revised enrollment and information change forms for Plan Year 2006:

• Group Health Insurance Application (ET-2301) Rev. 7/2005
• Health Insurance Information Change (ET-2329) Rev. 7/2005

For additional reporting forms or applications, please contact ETF’s Supply and Mail Services Section at (608) 266-3302.

“Tiering” on Monthly Coverage Reports

The WPE 2006 Monthly Coverage Report for each program option includes a check-box related to employer/employee premium share allocation. This box is located in the lower right corner of the form. Each month, check the box corresponding to the method you use to determine employer/employee contributions — either the traditional 105% or tiering. (See Subchapter 302, Health Insurance Employer Administration Manual (ET-1144) for information on tiering.)

Tips for Completing Health Insurance Applications and Corresponding Reports Throughout 2006

Enrollment applications, monthly reporting forms, and premium remittances must be complete and accurate to ensure proper and prompt health insurance coverage for your employees. In addition, statistics generated from the monthly data submitted by employers are used to track the movement of individuals between participating health plans and counties. This information is used in the rate setting process for the Group Health Insurance Program.

Subchapter 303 Health Insurance Employer Administration Manual (ET-1144) provides information concerning the “Prospective Date of Coverage” entered on the Group Health Insurance Application (ET-2301) and “Effective Date” entered on the Monthly Additions Report (ET-2610). Subchapter 503 provides information concerning effective dates of termination of coverage.

Health Insurance Reporting Codes

A copy of the codes used for reporting purposes (on monthly reports as well as health insurance applications and information change forms) is attached. Please use this as a quick reference when preparing these reports.

2006 Dual-Choice Due Dates and Reporting Instructions

The January 2006 health insurance reports are due Tuesday, December 20, 2005. Employers are encouraged to submit the January 2006 reports as early as possible, given the volume of changes resulting from Dual-Choice.

Note: Do not divide the January transactions between Dual Choice and “regular.” Both Dual-Choice and regular (non-Dual-Choice) transactions must be combined on the WPE Health Insurance Summary – 2006 form, WPE 2006 Monthly Coverage Report, Monthly Additions Report (ET-2610), Monthly Deletions Report (ET-2612), and the Monthly Changes Report (ET-2614).

January 2006 health insurance reports will include:

1. Two copies of the completed WPE Health Insurance Summary
   • A 2006 form for your appropriate program option and the corresponding WPE 2006; and
   • Monthly Coverage Reports for each health plan, indicating all of the contracts (Dual-Choice and non-dual-Choice) added and deleted for the coverage month of January 2006.
2. Two copies of the Monthly Additions Report (ET-2610), Monthly Deletions Report (ET-2612), and Monthly Changes Report (ET-2614) on which regular monthly transactions and Dual-Choice transactions (enrollment Type Codes 40 and 43 titled “Dual-Choice”) are combined.
• ETF Coverage Report plies of the Dual-Choice and the regular (non-Dual-Choice) applications must be attached to the corresponding Monthly Additions Report (ET-2610).

NOTE: Each entry on the Monthly Additions Report (ET-2610) must indicate the carrier suffix of the previous health (the employee’s current health plan). Do not substitute the name of the health plan for the carrier suffix.

• Monthly Deletions Report (ET-2612) for each health plan, listing each employee leaving that health plan at year-end, must be submitted.

Note: Each entry on the Monthly Deletions Report (ET-2612) must indicate the suffix number of the newly elected health plan. Do not substitute the name of the health plan for the health plan suffix number.

Alternate Reporting Requests

Written requests to use an alternate form of reporting or to deviate from completing/ assembling the reports in the manner described herein, must be submitted to ETF and must be approved in advance. Requests must include the alternate form(s) and/or alternate assembly method. Mail or e-mail request to:

Ron Diehl
Division of Trust Finance & Employer Services
Department of Employee Trust Funds
P O Box 7931
Madison, WI 53707-7931
E-mail ron.diehl@etf.state.wi.us

Assembly of all Health Insurance Reports for 2006 (Including January Dual-Choice Reporting)

Assemble your reports in the following order (resulting in two sets of reports in descending order, one set for ETF and one set for the carrier):

I. ETF Report Packet

1. WPE Health Insurance Summary – 2006. Attach the premium remittance check to the front of the Summary. (Please see instructions above for additional requirements for the Dual-Choice reports.)
2. WPE 2006 Monthly Coverage Report. Attach one Monthly Coverage Report per health plan with contracts to report. Assemble in the order in which the health plans are listed on the Monthly Coverage Report. (Please see instructions above for additional requirements for the Dual Choice reports.) Attach corresponding Monthly Additions Report (ET-2610), Monthly Deletions Report (ET-2612), and the Monthly Changes Report (ET-2614) with applications and other supporting documentation (stapled in the upper left corner) to the respective Monthly Coverage Report in the order listed below.
   • Monthly Additions Report (ET-2610). Assemble ETF Coverage Report plies of Group Health Insurance Application (ET-2301) in the order in which the specific subscriber information is listed on the Monthly Additions Report.
   • Monthly Deletions Report (ET-2612). Assemble any necessary supporting documents (such as the Group Health Insurance Cancellation Report [ET-1616]) in the order in which the specific subscriber information is listed on the Monthly Deletions Report.
   • Monthly Changes Report (ET-2614). Assemble ETF Coverage Report plies of Group Health Insurance Application (ET-2301) and/or Medicare Eligibility Statement (ET-4307) in the order in which the specific subscriber information is listed on the Monthly Changes Report.

II. Health Plan Report Packet (Carrier Copies)

1. Copy of WPE Health Insurance Summary – 2006
2. Copy of WPE 2006 Monthly Coverage Report. Attach one copy of Monthly Coverage Report per health plan with contracts to report. Assemble in the order in which the plans are listed on the Monthly Coverage Report. Attach corresponding Monthly Additions Report (ET-2610), Monthly Deletions Report (ET-2612), and the Monthly Changes Report (ET-2614) in the order listed below.
   • Monthly Additions Report (ET-2610) – No supporting documentation attached.
   • Monthly Deletions Report (ET-2612) – No supporting documentation attached.
   • Monthly Changes Report (ET-2614) – No supporting documentation attached.

Mail both sets of reports to:

Division of Trust Finance & Employer Services
Department of Employee Trust Funds
P.O. Box 7931
Madison, WI , 53707-7931

For questions on the proper way to assemble your monthly health insurance reports, call Ron Diehl at (608) 266-2737 or e-mail ron.diehl@etf.state.wi.us.