Vol. 18, State B
September 14, 2001
Health Insurance Dual-Choice Information
Dual-Choice Enrollment Period for 2002 is set for October
October 8-26, 2001 is the Dual-Choice Enrollment period for coverage
effective January 1, 2002. The Dual-Choice period for active and
retired employees, as well as former employees, who have continued
their insurance, takes place simultaneously. Dual-Choice provides
an opportunity for insured employees to change health insurance
plans and/or change from single to family coverage without a waiting
period for pre-existing conditions.
The 2002 It's Your Choice booklets will be supplied to
all state agencies prior to October 8 for distribution to your employees.
In November you will receive an Employer Bulletin containing
additional instructions for Dual-Choice reporting. The Department
of Employee Trust Funds (ETF) will send the monthly reporting forms
for 2002 during the second week of November 2001.
Dual-Choice Kick-off Meeting Reminder
The annual Dual-Choice Kick-off meeting will be held on Tuesday,
October 2, 2001 from 9:00 a.m. to 11:30 a.m. at the Mendota Mental
Health Institute Conference Center, 301 Troy Drive, Madison, Wisconsin.
Directions and a map were provided in Employer Bulletin
Vol. 18, No. 7 dated May 11, 2001. A copy of this Bulletin
is available on ETF Internet site at badger.state.wi.us/agencies/etf.
This meeting provides an opportunity for you to receive information
from health plan representatives and from ETF employees about health
plan changes taking place effective January 1, 2002. Please call
the Employer Communication Center at (608) 264-7900 with questions.
A list of Health Plan Contacts (ET-1728) will be available
at the Dual-Choice kick-off meeting.
Educational Teleconference Set
The UW Educational Telephone Network (ETN) has scheduled a telephone
conference from 9 a.m. to 10:20 a.m. on Thursday, October 18.
Bill Kox, ETF Director of Health Benefits and Insurance Plans, will
address questions about the Dual-Choice Enrollment period. For information
on the ETN locations in your area, check the ETN web site at
http://www.uwex.edu/ics/etn/siteinfo.htm, or contact the UW-Extension
Instructional Communication Service (ICS) at (608) 262-1598. You
may also check our Internet site at etf.wi.gov.
Notable Changes to Administrative Provisions Effective
January 1, 2002
- COBRA/Continuation – At the time COBRA/Continuation
is elected, a former covered dependent may elect a different plan
if the dependent resides in a county that does not include
a primary care physician in the subscriber's plan. The former
covered dependent may elect a different plan that is offered in
the county where the dependent lives. The Q&A section of the
It's Your Choice booklet has been modified to include
this change. The Continuation/Conversion Notice (ET-2311)
and instructions in the Group Health Insurance Employer Administration
Manual (ET-1118) will also be modified to include this change.
Watch for further instructions in a future Employer Bulletin.
EXAMPLE: A dependent ceases to be a full-time
student as of 12/31/2001. The subscriber is enrolled in Dean
Health Plan and lives in Dane County. The dependent however
lives in Milwaukee County where no primary care physician is
available through Dean Health Plan. The former dependent can
select any plan offered in Milwaukee County at the time COBRA/Continuation
Late Dual-Choice Network Change – If
a plan offers more than one network (i.e., Compcare, Humana,
Unity) and the service areas change, a subscriber who fails
to make a Dual-Choice election may change to the appropriate
network within the same plan. The change is effective the first
of the year or the first of the month after the employer receives
the application, whichever is later. Prior to the change, the
subscriber must use providers in the network currently enrolled.
If you receive an application or request from the subscriber
after the October 26, Dual-Choice deadline, process the application
with the later of an effective date of January 1, 2002 or the
first of the month following your receipt of the application.
Lifetime Benefit Maximums – A plan must
provide the subscriber with benefit accumulation information
- Plans newly available in these Counties
- SMP is a new option in Marinette County, as there is no qualified
Health Maintenance Organization (HMO) in this county.
- Barron County – Atrium Health Plan (qualifying)
- Bayfield County – Humana-Western (non-qualifying)
- Buffalo County – Health Tradition and Humana-Western
- Chippewa County – Atrium Health Plan (qualifying)
- Dodge County – Unity Community (non-qualifying)
- Dunn County – GHC-Eau Claire and Security Health Plan
- Eau Claire County – Atrium Health Plan (non-qualifying)
- Fond du Lac County – Dean Health Plan (qualifying)
- Green County – Unity–Community (qualifying)
- Outagamie County – Prevea Health Plan (non-qualifying)
- Pepin County – Humana-Western (non-qualifying)
- Price County – GHC-Eau Claire (non-qualifying)
- Richland County – Unity-Community (qualifying)
- Sauk County – Gundersen Lutheran (non-qualifying) and
Physicians Plus-SC qualifying)
- Trempealeau County – Humana-Western (non-qualifying)
- Out of State – Prevea Health Plan (non-qualifying)
- Plans no longer available
- CompcareBlue – Northwest (suffix .13). Note: The current
Northwest provider network will be included in the new CompcareBlue
– North (suffix .12). This change affects subscribers in
Ashland, Burnett, Clark, Douglas, Iron, Pepin, Pierce, Polk,
Price, Sawyer, St. Croix, Taylor and Washburn Counties.
- CompcareBlue – Southeast (suffix .11). This change affects
subscribers in Kenosha, Milwaukee, Ozaukee, Racine, Rock, Walworth,
Washington, and Waukesha Counties.
Current members of these plans must select another for 2002.
All of these plans will notify current members of the change.
- SMP is no longer available in the following counties:
- Adams County, due to Unity-Community now becoming a qualifying
plan in this county.
- Ashland County, due to CompcareBlue – North now becoming
a qualifying plan in this county.
- Green County, due to Unity-Community now becoming a qualifying
plan in this county.
Subscribers enrolled in SMP for these counties must select another
plan for 2002. 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.
- Plan name changes
- LaCrosseCare Plus (suffix .55) will change to Health Tradition
- CompcareBlue – Northwoods (suffix .12) will change to
CompcareBlue – North (suffix .12). This change affects
subscribers in Forest, Langlade, Lincoln, Marathon, Oneida,
Portage and Wood Counties.
No action by the subscriber is necessary as a result of these
- Plan Provider Network Changes
- Bayfield County – CompcareBlue - Northwest is no longer
available as a non-qualifying plan.
- Columbia County – Network-Fox Valley is no longer available
as a non-qualifying plan.
- Green County – Physicians Plus - SC is no longer available
as a non-qualifying plan.
- Jefferson County – GHC-South Central is no longer available
as a non-qualifying plan.
- Marquette County - Touchpoint Health Plan is no longer available.
- Pepin County – GHC-Eau Claire is no longer available.
- Portage County – Touchpoint Health Plan is no longer
- Rock County – GHC-South Central is no longer available.
- Out of State – Dean Health Plan, Mercycare Health Plan
and Valley Health Plan are no longer available.
- The geographic areas of each plan appear on the map on page
A-3. Subscribers should be encouraged to review the Plan Descriptions
in section G of It's Your Choice and to 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 2002.
Subscribers should contact their plans if they have not received
this information by October 11.
- Out of State Rates for Humana-Western
Humana-Western will continue to offer providers in Minnesota
through the Preferred One network. Due to misinformation from
the plan, Humana-Western is not listed under the Out of State
rates shown on page A-15 of the 2002 It's Your Choice
The 2002 monthly Out of State rates for Humana-Western are:
- Full-time employees: $367.60 for single coverage and $907.50
for family. No employee contribution is required for full-time
- Less than half-time employees: contribution is $50.03 per
month for single coverage and $130.71 for family coverage.
- $277.60 for single coverage and $682.50 for family. No employee
contribution is required.
- Notable Changes to Uniform Benefits for 2002
- Annual prescription drug out-of-pocket maximum will be $270
per individual and $540 for a family.
- Emergency room co-payment will be $40 per occurrence. The
co-payment will continue to be waived if the member is admitted
directly to the hospital.
- One hearing aid per ear will be covered every three years
at 80% (under Durable Medical Equipment [DME] benefit), up to
a maximum of $1,000 per hearing aid. The annual out-of-pocket
maximum of $500 for DME does not apply.
- Extraction of natural teeth and replacement with artificial
teeth because of accidental injury must occur within 18 months
- Changes to Standard Plan II
- The annual deductible (per person) will increase from $300
- The annual out-of-pocket maximum (per person) will increase
from $1,000 to $2,000.
- The prescription co-pay will change from $7 generic and $14
brand name to $7 generic and $21 brand name.
- Other information about Uniform Benefits
All uniform benefits are included in the ETF Internet site at
etf.wi.gov. Additional information
about the health insurance program and other insurance programs
offered to state employees is also available at this site.
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 2002 premiums for any change in the employee share.
- Verify that selected physicians, clinics, and/or hospitals are
still available under their plans in 2002.
- 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 booklet.
- Call the health plan directly with specific benefit or provider
Employees must return completed applications to change
plans to their employers no later than 4:30 p.m., Friday, October
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.
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, 2002 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 9, 2001. Please make sure that the employee selected
a primary care physician and that the employer portion of the
application is completed.
Remind employees to keep their 2002 It's Your Choice booklet
as a reference for the entire plan year.
It's Your Choice booklets must be distributed in a timely
manner to all insured employees including:
- Insured employees that have indicated they do not wish
to make a change during Dual-Choice. Remind these employees
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.
- 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) to employers along with copies of It's Your Choice
booklets. To request applications, contact ETF Supply and Mail Services
Section 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.
Remind Employees to Contact the Plans Directly with Questions,
and to Provide Plans with Current Mailing Addresses
Employees who request verification or explanation of service area
and/or provider availability related to Dual-Choice 2002 must contact
the plans directly. In doing so, your employees will receive the
most up-to-date information regarding providers or service areas.
PLEASE NOTE: In order to receive information pertinent
to the Group Health Insurance Programs administered by ETF, your
employees must identify themselves as a State of Wisconsin Plan
Please remind your employees who participate in the Group Health
Insurance plan they are responsible for providing their current
mailing addresses to their respective plans. The plans will take
employee address information over the telephone and report any changes
to ETF. Plans often tell us they are unable to contact current subscribers
due to incorrect addresses on file. Once mailing addresses are updated,
employees will receive provider information in a timely fashion.
This includes information related to student status, which will
enable dependents to continue their current health insurance.
Employer's Application Processing Instructions for
- Verify that the employee has completed the application in its
entirety. If an HMO is selected, there must be a Physician Name,
the county that the physician provides services in, and a Provider
Number (if known) entered on the application.
- Complete the Employer Portion of the application and provide
the following information on each Dual-Choice 2002 Health
- Employer Number (EIN)
- Name of Employer
- Payroll Representative Signature
- Telephone Number
- Group Number
- Enrollment Type 40 = Dual-Choice; 43 = Change from Single
- Employee Type
- Coverage Type Code
- Carrier Suffix
- Standard Plan Waiting Period if the Standard Plan is chosen
- Participant County Code – This county code represents
the county in which your employee resides
- Physician County Code – This county code represents the
county in which your employee receives primary care
- Date Received by Employer
- Date Employment Began – This box can be left blank, or insert
the date on which employment began with your agency.
- Monthly Employee Share
- Monthly Employer Share
- Event Date = January 1, 2002
- Prospective Date of Coverage = January 1, 2002
- Separate each type of application form (ET-2301 and ET-2302
for UW Graduate Assistants). Within each form type, separate enrollment
type 40 from enrollment type 43.
- Send the Advanced Carrier Registration Copy of your Dual-Choice
applications on a weekly basis directly to the plans. All Advance
Carrier plies must be forwarded to the plans by November 9, 2001.
This approach will assist ETF in ensuring that your employees
receive their new subscriber cards prior to January 1, 2002.Send
the ETF ply of your Dual-Choice applications on a weekly basis
directly to ETF. All ETF plies must be forwarded to ETF by November
- Give the employee their copy and keep the Employer Copy for
your records. Submit the Carrier Copy with your monthly Additions
Report to ETF by December 20, 2001.
Procedures for Withdrawing Dual-Choice Elections
Employees may rescind Dual-Choice elections by notifying their
employers in writing prior to December 31, 2001. 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
Additional Dual-Choice Instructions
Specific Dual-Choice instructions are found in Chapter 4 of your
Group Health Insurance Employer Administration Manual (ET-1118)
- Refer to Subchapter 403 if you have an employee who is initially
eligible for coverage in November or December or who terminates
employment in November or December.
- Refer to Subchapters 406 and 407 for the procedure to use if
you receive a Dual-Choice application after October 26, 2001.
Also note that late Dual-Choice material can be submitted to ETF
via Fax at (608) 266-5801.
Contact the Employer Communication Center at (608) 264-7900 with
all questions related to health insurance eligibility and reporting,
including any questions related to this Employer Bulletin.