Vol. 17, State H
November 17, 2000
Employee Reimbursement (ERA) Administrative Fee Decrease;
Health Insurance Portability and Accountability Act (HIPPA) Update
Program Administrative Fees for Employee Reimbursement
Accounts (ERA) Decrease in 2001
The administrative fee for the 2001 Employee Reimbursement Accounts
(ERA) Program will decrease from $.60 to $0.48 per month for each
health contract that has an employer-paid share reported to the
Department of Employee Trust Funds (ETF). This change is effective
with the health summary report due December 20, 2000 for January
Agencies should report the total fee (number of contracts x $0.48)
via the State Health Insurance Summary (ET-1608) form.
Even if an agency has no employees enrolled in the medical expense
or dependent care reimbursement portions of the ERA program, the
agency is still responsible for its share of ERA administrative
costs. For most state agencies, employer FICA savings due to pre-tax
funding of premiums, which remain in agency fringe benefit lines,
will more than offset ERA fees.
For more information about this fee structure, contact Marcia Blumer
at (608) 266-2640 or
firstname.lastname@example.org. If you have questions about reporting
and transmitting the fee with the State Health Insurance Summary
(ET-1608) form, contact Ron Diehl, Division of Employer Services
at (608) 266-2737 or
Health Insurance Portability and Accountability Act
(HIPAA) Special Enrollment for Health Insurance
Employees must enroll for health insurance during a designated
enrollment period. Enrollment options include submitting an application
for enrollment within 30 days of the date of hire if the employee
elects to pay the entire premium before employer contributions begin.
If the employee does not elect to enroll during the first 30 days,
the application must be received prior to the date employer contribution
begins. There are no interim effective dates. If the employee misses
both of these designated enrollment periods, the employee is limited
to the Standard Plan. By virtue of enrolling in the Standard Plan,
the employee will have a 180-day waiting period for all pre-existing
medical conditions except pregnancy.
Under certain situations HIPAA allows an employee to enroll during
the period in-between the two enrollment periods without being restricted
to the Standard Plan with a 180-day waiting period for pre-existing
conditions. HIPAA allows a special enrollment when an employee or
dependent is eligible but not enrolled and there is a marriage or
birth, adoption or placement for adoption, if coverage is elected
within 30 days of the event. Coverage is effective on the date of
birth, adoption, placement for adoption, or on the first of the
month following the request for enrollment following a marriage.
An employee with no previous WRS service begins WRS-eligible
employment. The employee does not elect health insurance coverage
within the first 30 days of employment. The employee's spouse
has a baby prior to the date the employer contribution begins.
HIPAA allows a special enrollment when an employee or dependent
is eligible but not enrolled and there is a birth, if coverage
is elected within 30 days of the date of birth. Coverage is effective
on the date of birth. The employee can elect family coverage by
submitting an application within 30 days of the birth.
HIPAA also provides for a special enrollment period when other
coverage is lost. A person meeting the requirements for this special
enrollment period would not be denied solely because it occurred
during the interim period (i.e., beyond the first 30 days of employment
and before the date employer contributions begin). The enrollment
period begins on the date other group health insurance coverage
terminates due to loss of eligibility (e.g., termination of employment,
divorce, etc., but not voluntary cancellation of coverage) or the
employer's premium contribution ends. An application and other information
documenting the employee's loss of coverage or loss of employer's
premium contribution must be submitted within 30 days of the date
the other coverage or employer's premium contribution ended. Coverage
will be effective on the date the other coverage or the employer's
premium contribution ends.
For more information about HIPAA, including when an employee or
dependent is eligible but not enrolled, contact ETF's Employer Communication
Center at (608) 264-7900.