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Employers

Employer Bulletin

State Agencies
Vol. 18, State B
September 14, 2001

Health Insurance Dual-Choice Information

Dual-Choice Enrollment Period for 2002 is set for October 8-26, 2001

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 is elected.

  • 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 upon request.

Plan Information

  1. 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 (both non-qualifying)
    • Chippewa County – Atrium Health Plan (qualifying)
    • Dodge County – Unity Community (non-qualifying)
    • Dunn County – GHC-Eau Claire and Security Health Plan (both non-qualifying)
    • 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)
  2. 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.

  3. 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.

  4. Plan name changes
    • LaCrosseCare Plus (suffix .55) will change to Health Tradition (suffix .55)
    • 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 name changes.

  5. 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 available.
    • 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.
  6. 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 booklet.

    The 2002 monthly Out of State rates for Humana-Western are:

    State Employees:

    • Full-time employees: $367.60 for single coverage and $907.50 for family. No employee contribution is required for full-time employees.
    • Less than half-time employees: contribution is $50.03 per month for single coverage and $130.71 for family coverage.

    Graduate Assistants:

    • $277.60 for single coverage and $682.50 for family. No employee contribution is required.
  7. 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 of injury.
  8. Changes to Standard Plan II
    • The annual deductible (per person) will increase from $300 to $500.
    • 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.
  9. 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.

General Information

Even if employees 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 2002.
  2. Review the 2002 premiums for any change in the employee share.
  3. Verify that selected physicians, clinics, and/or hospitals are still available under their plans in 2002.
  4. 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.
  5. Call the health plan directly with specific benefit or provider questions.

Employees must return completed applications to change plans to their employers no later than 4:30 p.m., Friday, October 26, 2001.

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.

Booklet Distribution

It's Your Choice booklets must be distributed in a timely manner to all insured employees including:

  1. 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.
  2. 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 employee.

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 Dual-Choice 2002

  1. 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.
  2. Complete the Employer Portion of the application and provide the following information on each Dual-Choice 2002 Health Insurance Application:
  • Employer Number (EIN)
  • Name of Employer
  • Payroll Representative Signature
  • Telephone Number
  • Group Number
  • Enrollment Type 40 = Dual-Choice; 43 = Change from Single to Family
  • 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
  1. 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.
  2. 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 9, 2001.
  3. 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 ETF.

Additional Dual-Choice Instructions

Specific Dual-Choice instructions are found in Chapter 4 of your Group Health Insurance Employer Administration Manual (ET-1118) revised 1/97.

  • 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.

 

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