Vol. 17, State G
September 15, 2000
Dual-Choice Period for 2001 Set for October 2-20, 2000
The Group Insurance Board has designated October 2-20, 2000 as
the Dual-Choice Enrollment period for coverage effective January
1, 2001. Sufficient quantities of the It's Your Choice 2001 booklets will
be supplied to all state agencies prior to October 2.
This Bulletin contains: plan information; general Dual-Choice
information; application submission deadlines; booklet distribution
information; details regarding withdrawing Dual-Choice applications;
2001 Premium Rates By County for Less Than
Half-time Employees; 2001 Premium Rates By County for Full-time
Employees; and 2001 Premium Rates for Annuitants.
A list of Health Plan Contacts
(ET-1728) will be available at the Dual-Choice kick-off meeting
set for September 26, 2000 at the Radisson Inn in Madison.
ETF will send the monthly reporting forms for 2001 during the second
week of November 2000.
Employees 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 employees. Employees should
verify with the plans that providers are still available.
1. New Plans
CompcareBlue - Northeast (suffix .14) - is being offered as
a separate network in Brown, Manitowoc, and Sheboygan Counties.
This plan was part of Compcare-Southeast in 2000.
CompcareBlue - Aurora/Family (suffix .16) has many of the same
providers that were offered through Family Health Plan. This
plan may be offered in Milwaukee and Waukesha Counties. Members
should call toll-free 1-866-843-9724 before enrolling to verify
SMP will be offered in Adams and Green Counties, as there are
no qualified HMOs in these counties in 2001.
2. Plans no longer available
Family Health Plan (suffix .20) - affects Milwaukee and Waukesha
Humana/Emphesys - Racine (suffix .23) - provider network will
be offered through Humana-Eastern (suffix .21) - affects Kenosha
and Racine Counties.
HMP-90 North Central (suffix .44) - affects out-of-state, Barron,
Chippewa, Clark, Dunn, Eau Claire, Langlade, Lincoln, Marathon,
Marinette, Oconto, Oneida, Portage, Price, Rusk, Taylor, Vilas,
Washburn and Wood Counties.
Network - Community (suffix .69) - affects Calumet, Kenosha,
Milwaukee, Ozaukee, Racine, Sheboygan, Washington and Waukesha
Counties. This change does not affect Network - Fox Valley (suffix
Physicians Plus - Southeastern (suffix .75) - affects Milwaukee,
Ozaukee, Washington and Waukesha Counties. This change does
not affect Physicians Plus - South Central (suffix .74). However,
members should verify that their providers are still available
Current members of these plans must select another for 2001. All
of these plans will notify current members of the change. If an
election is not made, an application will have to be obtained for
the Standard Plan (not Standard Plan II).
3. SMP no longer available in the following
Marinette County, due to expanded availability of an alternate
plan (Prevea Health Plan) in this county. Subscribers enrolled
in SMP must select another plan for 2001. If a new plan is not
selected, participants will have to receive medical care from
SMP providers in a county in which SMP is still offered.
4. Plan name changes
Humana/Emphesys - Milwaukee (suffix .21) will change to Humana-Eastern
Humana/Emphesys - Wisconsin (suffix .22) will change to Humana-Western
No action by the subscriber is necessary as a result of these
5. Plan Provider Network Changes
Compcare - Northwoods is no longer available as a non-qualifying
plan in Waupaca County.
Compcare - Southeast is no longer available in Brown County.
Dean Health Plan is no longer available in Green County.
Humana/Emphesys - Wisconsin (now Humana-Western) is no longer
available in Jackson County. Humana-Western is being offered
as a qualifying plan in Burnett and Dunn Counties.
Physicians Plus - Southcentral is no longer available in Dodge,
Grant, Jefferson, Juneau, Lafayette, Marquette, Richland, Sauk,
Walworth and Waukesha Counties.
Prevea is no longer available as a non-qualifying plan in Shawano
Security is being offered as a non-qualifying plan in Washburn
and Waushara Counties.
Touchpoint is being offered as a non-qualifying plan in Marquette
County and as a qualifying plan in Door County.
Unity-Community and Unity-UW Health plans have made a number
of significant network changes. Subscribers outside Dane County
should verify whether their providers remain in the same Unity
network for 2001.
Unity-UW Health will only be offered in Dane County.
Unity-UW Health is no longer available in Rock County.
Unity-Community will be offered in Columbia (qualifying)
and Jefferson (non-qualifying) Counties. Current members
of Unity-UW Health living in Columbia or Jefferson Counties
should be encouraged to select another plan for 2001 and
file an application. If no applications are filed by these
members, they will only be allowed to use the providers
listed with Unity-UW Health in Dane County.
Other network changes appear on the map on page A-3 and the
Plan Descriptions in section F of It's Your Choice
or subscribers should contact the plans directly.
The subscriber's current plan is required to provide a
list of all plan providers that will not be available in 2001.
Subscribers should contact their plans if they have not received
this information by October 6th.
6. Changes to the Uniform Benefits, SMPand
Medicare Plus $100,000 prescription drug co-payment and annual out-of-pocket
Co-payment will be $5 for generic drugs and $10 for brand name
drugs for up to a 34-day supply.
Annual out-of-pocket maximum will be $240 per individual and
$480 for a family.
7. New Coverage under Uniform Benefits, Medicare
Plus $100,000, Standard II (not Standard Plan) and SMP
Pharmacotherapy for smoking cessation will be covered as any
other prescription. This benefit will provide coverage for smoking
cessation products that require a written prescription and are
prescribed by a plan provider, such as Zyban, nicotine inhalers
or sprays. Over-the-counter products are not covered. Coverage
is limited to one three-month course of pharmacotherapy per
The health plans may require a referral or pre-authorization
for these products. Participants should contact the plans directly
during Dual-Choice to determine how the plan will administer
8. Other Changes to Standard Plan II
The annual deductible will increase from $200 per person to
$300, with a maximum of two per family.
The annual out-of-pocket maximum will increase from $750 to
$1,000, with a maximum of two per family.
9. Other information about Uniform Benefits
Routine maintenance and replacement tires and batteries for
durable medical equipment will be covered. Participants still
must obtain prior authorization from the plan if the purchase
will exceed $200.
There are no annual dollar maximums for mental health services
in 2001. The dollar maximums continue to be suspended due to
the federal Mental Health Parity Act. Annual day limits for
inpatient mental health services and annual dollar maximums
for alcohol and drug abuse treatment remain in force and are
combined with mental health services for determining if benefits
for alcohol and drug abuse have been exhausted.
The uniform benefits are included in the ETF website at
http://etf.wi.gov. Additional information
about the health insurance program and other insurance programs
offered to state employees is also available at this site.
General Information about Dual-Choice
Dual-Choice provides an opportunity for insured employees to change
health insurance plans, and/or to change from single to family coverage
without a waiting period for pre-existing conditions.
Even if employees want to continue participation in their current
plan, they should still do the following:
Verify that their current plans are available in their area
Review the 2001 premiums for any change in the employee share.
Verify that selected physicians, clinics, and/or hospitals
are still available under their plans in 2001.
Review changes in benefits by reading the "Notable Plan
and Program Changes" section, as well as the individual
plan descriptions found in the It's Your Choice
Call the health plan directly with specific benefit or provider
Completed applications to change plans must be returned
to employers no later than 4:30 p.m., Friday, October 20, 2000.
Employees 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 booklets
identify 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 contributions for the Standard Plan and Standard
Plan II are based upon the employee's county of residence.
The Dual-Choice period for active and retired employees,
as well as former employees, who have continued their insurance,
takes place simultaneously.
ETF will mail It's Your Choice booklets, complete
with special application forms, directly to retirees and former
employees (health insurance continuants). If you have employees
that want to change plans and who will retire effective January
1, 2001 or later, they must complete applications as active employees.
Changes in annuitant coverage will be handled by ETF when employees
apply for annuitant benefits.
NOTE: Forward all carrier advance registration
copies of the Dual-Choice applications to the plans by Friday, November
10, 2000. Please make sure that the employee selected a primary
care physician and that the employer portion of the application
It's Your Choice booklets must be distributed in a
timely manner to all insured employees. Please remind employees
to keep the booklet as a reference for the plan year. These distributions
Insured employees that have indicated they do not wish
to make a change during Dual-Choice. These employees
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
Insured employees on layoff or leave of absence.
Employees 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 booklets due to the
small percentage of employees 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 Employees
New employees initially eligible for coverage on November 1 or
December 1, 2000 must file two applications during their regular
enrollment period if they wish to enroll in a different plan beginning
January 1, 2001. The first application will cover the period from
the date of initial coverage through December 31, 2000. The second
application changes their health insurance to the plan of their
choice for 2001, and must have the "Dual-Choice" box checked.
Procedure for Employees Who Terminate in November or December
after Making a Dual-Choice Election
For employees who 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
If an employee's termination date is such that he or she will
still be eligible for health insurance coverage after January 1,
2001, and the employee has also notified your office within 30 days
of a move, a new health insurance application must be submitted.
The appropriate Transfer, Deletion and Addition Reports must be
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 employee moved out of the service area
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 employee. However, if the effective date of the move is the
same as or after the date the coverage ends, ETF will make the applicable
Procedures for Withdrawing Dual-Choice Elections
Employees may rescind Dual-Choice elections by notifying their
employers in writing prior to December 31, 2000. The written request
should be filed with the employee's records. When you receive
a request to rescind, make three copies of your ply of the Dual-Choice
application and write "Rescind" across each copy. Forward
one copy to the current plan, one copy to the plan indicated as
"Plan Selected" and send one copy to ETF.
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.
Attachments: 2001 Premium Rates by County for Less than Half-time
Employees, 2001 Premium Rates by County for Full-time Employees
and 2001 Premium Rates for Annuitants.