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Employers

Employer Bulletin

State Agencies
Vol. 16, State D
September 16, 1999

DUAL-CHOICE PERIOD FOR 2000 SET FOR OCTOBER 4-22, 1999

The Group Insurance Board has designated October 4-22, 1999 as the Dual-Choice Enrollment period for coverage effective January 1, 2000. It's Your Choice booklets for the year 2000 will be supplied in sufficient quantities to all state agencies prior to the beginning of Dual-Choice.

This Bulletin contains: plan information; application submission deadlines; booklet distribution information; details associated with rescinding Dual-Choice applications; 2000 Premium Rates By County for Less Than Half-time Employes; 2000 Premium Rates By County for Full-time Employes; and 2000 Premium Rates for Annuitants.

Health Plan Contacts (ET-1728) will be available at the Dual-Choice Kick-off meeting on September 29, 1999.

ETF will send the monthly reporting forms for 2000 during the second week of November 1999.

Employes with questions regarding network changes should contact their plans. The state map on page A-3 and the Plan Descriptions in Section F in the new It's Your Choice booklet will also clarify how these changes may impact employes. Employes should verify with the plans that providers are still available.

Plan Information

There are few plan changes occurring as a part of Dual-Choice 2000.

  1. Two Plans No Longer Available:

    Managed Health Services(carrier suffix .58) no longer available in Kenosha, Milwaukee, Ozaukee, Racine, Washington and Waukesha Counties

    North Central Health Protection Plan Southern Region (carrier suffix .51) no longer available in Langlade, Lincoln, Marathon, Portage, Price, Taylor and Wood Counties.

    North Central Health Protection Plan Northern Region (carrier suffix .52) no longer available in Forest, Lincoln, Oneida and Vilas Counties

    Current members of these plans must select another for 2000. Both plans will notify current members of the change.

    Important Note: If an election is not made, an application will have to be obtained for the Standard Plan (not Standard Plan II).

  2. Standard Plan and Medicare Plus $100,000 Changes

    Changes to the Standard Plans and Medicare Plus $100,000 will occur January 1, 2000. Changes are necessary due to substantial increases in physician, hospitalization and pharmacy costs. It is important to note that 97% of the premium collected for the Standard Plans goes directly for payment of claims.

    Prior to Dual-Choice, participants in these plans will receive letters from Blue Cross Blue Shield United of Wisconsin providing detailed information about the following changes approved by the Group Insurance Board:

    Changes to the Standard Plan II benefits are necessary to keep monthly premium increases more affordable. The annual deductible for Standard Plan II will increase from $100 to $200 for single coverage, maximum of two per family coverage. The annual out-of-pocket maximum will increase from $500 to $750 for single and $1500 for family.

    Participants in the Standard and Standard II Plans will have a prescription drug card available, which will eliminate the need to file claims for reimbursement of covered prescriptions and should reduce overall drug costs. New co-payments have been established on a "per prescription" basis. Participants will pay $7 per prescription for generic equivalents and $14 for brand name drugs. This co-payment level was set to be equivalent, on average, to the 20% coinsurance participants previously paid. For any individual prescription, the $7/$14 co-payment may be more or less than the amount that the 20% previous coinsurance requirement yielded.

    Medicare Plus $100,000 and SMP will have co-payments implemented for prescription drugs. The co-payment and SMP will be $4.00 for generic equivalent drugs and $8.00 for brand name drugs, which is payable at the time the prescription is purchased. There is a maximum annual out-of-pocket cost to the participants of $130 per individual and $260 per family. SMP participants will also have the prescription drug card discussed above (Medicare Plus $100,000 has used the drug card since 1996).

  3. Other Plan Changes

    The State Maintenance Plan (SMP) will be available in Pierce County.

    The table on page three identifies plan changes specific to certain counties and regions.

  4. Name Change

    United Health of Wisconsin (carrier suffix .94) has changed their name to Touchpoint Health Plan (carrier suffix .94). No action by the participant is necessary as a result of the name change.

General Information About Dual-Choice

Dual-Choice provides an opportunity for insured employes to change health insurance plans, and/or to change from single to family coverage without a waiting period for pre-existing conditions.

Important: Even if employes want to continue participation in their current plan, they should still do the following:

  1. Verify that their current plans are available in their area for 2000.

  2. Review the 2000 premiums for any change in the employe share.

  3. Verify that selected physicians, clinics, and/or hospitals are still available under their plans in 2000.

  4. Review changes in benefits by reading the "Notable Plan and Program Changes" section, as well as the individual plan descriptions, in the Dual-Choice booklet.

  5. Call the health plan directly with specific benefit or provider questions.

County-By-County Health Plan Changes

Plan Newly Available No Longer Available County
Compcare Northwest

X

  Out of State*
Compcare Northwoods

X

  Waupaca*
Compcare Northwoods  

X

Shawano
Compcare Southeast  

X

Jefferson
Compcare Southeast

X

  Manitowoc*
Dean Health Plan

X

  Kenosha*

Racine*

HMP-90 North Central

X

  Out of State*
HMP-90 North Central  

X

Forest
Humana/Emphesys- Milwaukee

X

  Fond du Lac*

Manitowoc*

Rock*

Sheboygan*

Walworth

Humana/Emphesys – Wisconsin

X

  Out of State*
Humana/Emphesys – Wisconsin  

X

Rock
LaCrosse Care Plus

X

  Crawford
Mercycare

X

  Out of State*
Network – Community

X

  Calumet*
Network – Community  

X

Walworth
Network – Fox Valley

X

  Portage*

Sheboygan*

Network – Fox Valley  

X

Columbia
Prevea

X

  Marinette
Security

X

  Dunn*
Security  

X

Washburn
United Health of Wisconsin  

X

Marinette

Marquette

Unity – Community  

X

Green Lake

LaFayette

Waushara

Unity – UW Health  

X

Dodge

Fond du Lac

* This plans monthly premium in this county was not used to calculate the "State Pays" amount because of limited provider availability.

Completed applications to change plans must be returned to employers no later than 4:30 p.m., Friday, October 22, 1999.

Employes may select any alternate plan regardless of their resident counties, but should be sure that the providers are within reasonable distance for medical care. It's Your Choice identifies geographic areas covered by each plan.

The state premium contribution for Health Maintenance Organizations (HMOs) is based upon the county in which medical care is received. The state premium contribution for the Standard Plan, Standard Plan II and HMP-90 are based upon the employe's county of residence.

The Dual-Choice period for active and retired employes, as well as former employes who have continued their insurance, takes place simultaneously.

ETF and/or the plans will mail It's Your Choice booklets, complete with special application forms, directly to retirees and former employes (health insurance continuants). If you have employes that want to change plans and who will retire effective January 1, 2000 or later, they must complete applications as active employes. Changes in annuitant coverage will be handled by ETF when employes apply for annuitant benefits.

NOTE:

Forward all carrier advance registration copies of the Dual-Choice applications to the plans by Friday, November 5, 1999. Please make sure that the employe selected a primary care physician and that the employer portion of the application is completed.

Specific Instructions

Booklet Distribution

It's Your Choice booklets must be distributed in a timely manner to all insured employes. This includes:

  1. Insured employes that have indicated they do not wish to make a change during Dual-Choice. These employes should be reminded that they remain responsible for understanding the information contained in the booklet and that it serves as their certificate of coverage if they are enrolled in an alternate plan.

  2. Insured employes on layoff or leave of absence. NOTE: Employes who have let their health insurance lapse while on leave of absence or layoff 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) with It's Your Choice books due to the small percentage of employes actually electing to change health plans during Dual-Choice. To request these forms or if you need Health Insurance Information Change forms (ET-2329), 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. Also, note that your request is Dual-Choice related.

Procedure for New Employes

New employes initially eligible for coverage on November 1 or December 1, 1999 must file two applications during their regular enrollment period if they wish to enroll in a different plan beginning January 1, 2000. The first application will cover the period from the date of initial coverage through December 31, 1999. The second application changes their health insurance to the plan of their choice for 2000, and must have the "Dual-Choice" box checked.

Procedure for Employes Who Terminate in November or December After Making a Dual-Choice Election

For employes that terminate in November or December after making a Dual-Choice election, the plan elected during the Dual-Choice Enrollment period is the plan to record in the "plan information section" of the subsequent Continuation-Conversion Notice (ET-2311).

If an employe's termination date is such that he or she will still be eligible for health insurance coverage after January 1, 2000, and the employe has also notified your office within 30 days of a move, a new health insurance application must be submitted and the appropriate Transfer, Deletion and Addition Reports attached to the corresponding Coverage Reports. In this instance, the plan information indicated on the Continuation-Conversion Notice (ET-2311) should reflect the new plan.

If you are notified that an employe's move occurred after the termination date but prior to the date the coverage ends, you should report the applicable change as you would for any other active employe. However, if the effective date of the move is the same as or after the date the coverage ends, ETF will make the applicable plan contacts.

Procedures for Withdrawing Dual-Choice Elections

Employes may rescind Dual-Choice elections by notifying their employers in writing prior to December 31, 1999. The written request should be filed with the employe's records. When you receive a request to rescind, make two copies of your ply of the Dual-Choice application and write "Rescind" across each copy. Forward one copy to the current plan and the other copy to the plan indicated as "Plan Selected".

Please contact the Employer Communication Center at (608) 264-7900 with all questions associated with health insurance eligibility and reporting, including any concerns related to Dual-Choice or this specific Employer Bulletin.

 

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