Vol. 19, State F
September 19, 2002
Health Insurance Dual-Choice Information
Location Change for Dual-Choice Kick-off Meeting
Quality Inn South
4916 East Broadway
Madison, WI 53716
Date: Tuesday, October 1, 2002
Time: 9:00 a.m. – 11:30 a.m.
Due to a major remodeling effort underway at the Mendota Mental
Health Conference Center, the location for the annual Dual-Choice
Kick-off meeting has been changed. Please join us at the Quality
The Dual-Choice Kick-off meeting provides an opportunity for you
to receive information from health plan representatives and from
ETF employees regarding health plan changes that will take place
January 1, 2003. Please call the Employer Communication Center
at (608) 264-7900 with questions.
Dual-Choice Enrollment Period for 2003 is set for October
October 7-25, 2002 is the Dual-Choice Enrollment period for coverage
effective January 1, 2003. Dual-Choice provides an opportunity for
insured subscribers (active employees, annuitants, and former employees
who have continued their coverage) to change health insurance plans
and/or change from single to family coverage without a waiting period
for pre-existing conditions.
The 2003 It's Your Choice booklets will be supplied to all
state agencies prior to October 7 for distribution to 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 2003
during the second week of November 2002.
Note: Corrections to the 2003 It's Your Choice
booklet (ET-2107 rev 10/02)
Plan description pages for Health Tradition, Medical Associates,
MercyCare, Network, Prevea, and Touchpoint erroneously state that
the prescription drug dispensing policy provides up to a 34-day
supply per co-pay. The prescription drug dispensing policy outlined
in Uniform Benefits for 2003 provides up to a 30-day supply
We regret the error and ask that employers notify their employees
of this change via e-mail, employer newsletters, bulletin board
postings and/or "insert" pages for the Dual Choice Book.
Teleconference through UW-Extension's WisLine
Web and Teleconferencing Service
ETF is sponsoring a teleconference through the UW-Extension's
WisLine Web and Teleconferencing Service. The conference is set
for Tuesday, October 15, from 9:00 a.m. to 10:30 a.m. and will address
questions about the Dual-Choice Enrollment period. To obtain information
concerning the WisLine Web and Teleconferencing site in your area,
you may check the web site at
or you may contact the UW-Extension Instructional Communication
Service (ICS) at (608) 262-7590, or you may visit our Internet site
Notable Changes to Administrative Provisions
- 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) was modified
to include this change. Employer Bulletin Vol. 19, No. 13, dated
July 15, 2002 provides further instructions for handling this
EXAMPLE: A dependent ceases to be a full-time student as of 12/31/2002.
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 25, Dual-Choice deadline, process the application
with the later of an effective date of January 1, 2003 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
Plans newly available in these Counties
- SMP is a new option in Kewaunee, Lincoln and Rusk Counties,
as there is no qualified Health Maintenance Organization (HMO)
in these counties.
- Columbia County – Network-Fox Valley (non-qualifying)
- Dane County – Humana-Eastern and MercyCare Health Plan
- Florence County – Humana-Western (non-qualifying)
- Green County – Dean Health Plan (qualifying)
- Iron County – Humana-Western (non-qualifying)
- Jefferson County – Humana-Eastern (qualifying)
- Juneau County – Dean Health Plan and Health Tradition
- Marinette County – Humana-Western and Touchpoint Health
Plan (both non-qualifying)
- Oconto County – CompcareBlue Northeast (non-qualifying)
- Richland County – Physicians Plus-South Central (qualifying)
- Sawyer County – Humana-Western (non-qualifying)
- Vernon County – Dean Health Plan (non-qualifying)
- Out of State – Dean Health Plan and Humana-Eastern
Plans no longer available
- Security Health Plan (suffix .71). This
change affects subscribers in Barron, Chippewa, Clark, Dunn,
Eau Claire, Forest, Iron, Jackson, Langlade, Lincoln, Marathon,
Oneida, Portage, Price, Rusk, Sawyer, Shawano, Taylor, Trempealeau,
Vilas, Washburn, Waupaca, Waushara and Wood Counties.
Current members of this plan must select another for 2003.
Security Health Plan will notify current members of the change.
If an application is not made, an application will have to be
obtained for the Standard Plan (not Standard Plan II).
No counties lost their SMP status.
No Plan name changes.
Plan Provider Network Changes
- Barron County – Humana-Western has switched from non-qualifying
to qualifying. Valley Health Plan has switched from qualifying
- Bayfield County – Humana-Western is no longer available.
- Brown County – Network-Fox Valley is no longer available.
- Burnett County – Humana-Western has switched from non-qualifying
- Chippewa County – Humana-Western has switched from
non-qualifying to qualifying.
- Columbia County – Physicians Plus-South Central has
switched from non-qualifying to qualifying.
- Crawford County – Health Tradition has switched from
qualifying to non-qualifying.
- Dodge County – Humana-Eastern has switched from non-qualifying
- Douglas County – Humana-Western has switched from non-qualifying
- Dunn County – Valley Health Plan has switched from
qualifying to non-qualifying.
- Eau Claire County – Atrium Health Plan has switched
from non-qualifying to qualifying.
- Fond du Lac County – Humana-Eastern and Network-Fox
Valley have switched from non-qualifying to qualifying. Touchpoint
Health Plan has switched from qualifying to non-qualifying.
- Grant County – Gunderson Lutheran has switched from
non-qualifying to qualifying.
- Iowa County – Unity-Community has switched from qualifying
- Jackson County – Valley Health Plan is no longer available.
- Kewaunee County – Touchpoint Health Plan has switched
from qualifying to non-qualifying.
- Manitowoc County – Humana-Eastern has switched from
qualifying to non-qualifying.
- Polk County – CompcareBlue-North is still available
but has switched from qualifying to a non-qualifying plan.
- Price County – GHC-Eau Claire is no longer available.
- St. Croix County – GHC-Eau Claire is no longer available.
CompcareBlue-North and Valley Health Plan are still available
but have switched from qualifying to non-qualifying plans.
- Taylor County – CompcareBlue North has switched from
non-qualifying to qualifying.
- Waukesha County – Dean Health Plan has switched from
qualifying to non-qualifying.
- 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
- The subscriber's current plan is required to provide
a list of all plan providers that will not be available in
2003. Subscribers should contact their plans if they have
not received this information by October 11.
Notable Changes to Uniform Benefits for 2003
- Annual prescription drug out-of-pocket maximum will be $300
per individual and $600 for a family.
- The prescription drug card co-payment for brand name drugs
only will increase from $10 to $17.25 per prescription. The
generic co-payment is not changing. It will remain at $5 per
- The prescription drug day supply will decrease from 34 days
to 30 days per prescription. The maximum for oral contraceptives
will be one co-pay per package.
- Cochlear Implants will be covered at 80% subject to Medical
Necessity criteria as determined by the Plan.
- The lifetime maximum per participant is increasing from
$1,000,000 to $2,000,000.
- Ambulance service will be paid at 100% as medically necessary
in 2003. This is increased from 100% coverage up to $300 ground,
$1,000 air transport.
- Orthoptic (eye training exercises) will be covered for up
to two sessions as medically necessary.
Other information about Uniform Benefits
All uniform benefits are included in the ETF Internet site
Additional information about the health insurance program
and other insurance programs offered to state employees is
also available at this site. Active state employees may put
money into the ERA program to cover out-of-pocket medical
costs by using pre-tax dollars.
Employees wanting to continue participation in their current plans
should do the following:
- Verify that their current plans are available in their area
- Review the 2003 premiums for any change in the employee share.
- Verify that selected physicians, clinics, and/or hospitals are
still available under their plans in 2003.
- 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 county
of residence, but should consider whether the providers are within
a 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
(HMO's) 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). Employees who wish to change plans and who
will retire effective January 1, 2003 or later, 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 8,
2002. 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 2003 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
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. In addition, note that your request is Dual-Choice
Remind Employees to Contact the Plans Directly with Questions,
and to Provide Plans with Current Mailing Addresses.
Employees requesting verification or explanation of service area
and/or provider availability related to Dual-Choice 2003 must contact
the plans directly. In doing so, 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 that 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 2003
Verify that the employee has completed the application in its
entirety. If an HMO is selected, a Physician Name, the county
in which the physician provides services, and a Provider Number
(if known) must be entered on the application.
Complete the Employer Portion of the application and provide
the following information on each Dual-Choice 2003 Health Insurance
- 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, 2003
- Prospective Date of Coverage = January 1, 2003
Separate each type of application form (ET-2301 and ET-2302
for UW Graduate Assistants).
Each week, send the Advanced Carrier Registration Copy of Dual-Choice
applications directly to the plans. All Advance Carrier plies
must be forwarded to the plans by November 8, 2002. This approach
will assist ETF in ensuring that your employees receive their
new subscriber cards prior to January 1, 2003.
Each week, send the ETF ply of Dual-Choice applications directly
to ETF. All ETF plies must be forwarded to ETF by November 8,
Give the employee their copy and keep the Employer Copy for
your records. Submit the Carrier Copy with the monthly Additions
Report (ET-2610) to ETF by December 20, 2002.
Procedures for Withdrawing Dual-Choice Elections
Employees may rescind Dual-Choice elections by notifying their
employers in writing prior to December 31, 2002. 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 follow
if you receive a Dual-Choice application after October 25, 2002.
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.