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Employers

Employer Bulletin

State Employers
Vol. 20, State D
September 29, 2003

Health Insurance Dual Choice Information

Dual-Choice Enrollment Period Set for October 6-24, 2003

October 6-24, 2003 is the Dual-Choice Enrollment period for coverage effective January 1, 2004. 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 2004 It's Your Choice booklets will be supplied to all State agencies prior to October 6. Please distribute them to your employees. In November, you will receive an Employer Bulletin containing additional instructions for Dual-Choice reporting. The Department of Employee Trust Funds (DETF) will send the monthly reporting forms for 2004 during the second week of November 2003.

Dual-Choice Kick-off Meeting Reminder

The annual Dual-Choice kick-off meeting is set for Wednesday, October 1, 2003, from 9:00 a.m. to 11:30 a.m. at Mendota Mental Health Institute Conference Center, 301 Troy Drive, Madison, Wisconsin. Directions and a map were provided in Employer Bulletin Vol. 20, No 7 dated May 23, 2003. Employer Bulletin Vol. 20, No 11 (dated August 8, 2003) provided employers with a registration form for the Kick-off Meeting. Room size is limited and you must pre-register for the Dual Choice Kick-off meeting. Copies of these Bulletins are available on the Employer Section of DETF's Internet site.

The Dual-Choice Kick-off meeting provides an opportunity for you to receive information from health plan representatives and from DETF employees regarding health plan changes that will take place effective January 1, 2004. Please call the Employer Communication Center at (608) 264-7900 with questions.

Education Teleconference Set

Employees, retirees and employers have an opportunity to participate in a statewide teleconference on the Dual-Choice health insurance program on Tuesday, October 14, from 9:00 a.m – 11:00 a.m.

The Wisconsin Coalition of Annuitants, UW-Extension, UW Colleges, and Epsilon Sigma Phi will sponsor an educational teleconference through the UW-Extension Instructional Communications Systems WisLine Teleconference Service. This teleconference will feature Bill Kox, DETF Director of Health Benefits and Insurance Plans, on the topic of "How to Make the Most Out of Dual-Choice in Light of Program Changes." Time will be made available to answer questions on any topic related to the State Health Insurance Program.

To participate, contact the site in your county. See http://www.uwex.edu/ics/wisline for a list of Group Conferencing Sites, or call (608) 262-1598. If you are unable to travel to one of the sites, you may connect to the teleconference from any telephone by dialing 1-888-677-9189 and entering 0994# when prompted. A limited number of phone lines are available, so please arrange group sessions where possible.

Notable Changes to Administrative Provisions

  • Pharmacy Benefit Manager: In July 2003, the Group Insurance Board authorized DETF to contract with a Pharmacy Benefit Manager (PBM) to provide pharmacy benefits to all State of Wisconsin group health insurance participants. Beginning January 1, 2004, all participants will receive their pharmacy benefits from the PBM, Navitus Health Solutions. Participants will receive an identification card from Navitus, which is separate from the ID card they get from their health plans. For more information about the PBM, please visit the Department's Web site.
  • Premium Contributions: The Group Insurance Board has recommended changing the current health insurance premium structure to a three-tiered program. DETF evaluated each health plan's costs of providing benefits to members and placed them in tiers, based on their ability to control costs while providing quality health care. Plans that proved to be most cost-effective were placed in Tier 1; moderately cost-effective plans in Tier 2; and the least cost-effective in Tier 3. Employee share of the premium is dependent upon the tier placement of the selected plan. Employees in this system will pay the same contribution for any plan within a tier.
  • Student Status Letters: DETF annually requires participating health insurance plans to send out the full-time student/disabled dependent status letter. This mailing is scheduled to take place in late October, earlier than in past years. Plans are permitted to terminate dependents if no reply is received by December 1, 2003. The termination date for former dependents is the last date of eligibility, which in most cases is December 31, 2003.

Plan Information

Standard Plan Redesign

Effective January 1, 2004, The Standard Plan (suffix .01) and Standard Plan II will be converted to one Standard Plan with a preferred provider network, with the option to go outside the network at additional cost. This change still allows participants to see any provider of their choice, but there are differences in reimbursements depending on whether they go to an in-network or an out-of-network provider. Note that the Standard Plan for 2004 has similarities to the benefits of the old Standard Plan and the Standard Plan II, and it is different than the Uniform Benefits offered by the Health Maintenance Organizations. The Standard Plan II will no longer be offered effective January 1, 2004.

Care received within the provider network will have the benefit level based on the former Standard Plan. For care received from non-network providers, the benefit level will be based on the former Standard Plan II. Since the provider network is nationwide, most covered members who receive out-of-state care will have access to the higher benefit level. Employees who are currently a Standard Plan or Standard Plan II member do not have to file a new health insurance application to enroll in the new Standard Plan, they will be auto-matically enrolled in this plan effective January 1, 2004. For more information about the conversion, please visit our Web site.

State Maintenance Plan (SMP)

In addition to being offered in counties where no qualified plan is available, the SMP will also be offered in counties where no qualified Tier 1 plan is available. See DETF's Web site at http://etf.wi.gov/standard.htm for additional information about deductibles and SMP's specialty care and hospital network.

Plans No Longer Available

Compcare Blue North (suffix .12). This change affects subscribers in Ashland, Burnett, Clark, Douglas, Forest, Iron, Langlade, Lincoln, Marathon, Oneida, Pepin, Pierce, Polk, Portage, Price, Sawyer, St. Croix, Taylor, Vilas, Wood, and Washburn Counties.

Current members of this plan must select a different plan for 2004. Compcare Blue North will notify current members of the change. If a new application is not made during Dual Choice, an application will have to be obtained for the Standard Plan.

New Plans Available

Compcare Blue Southeast (suffix .11). This change affects subscribers in Kenosha, Ozaukee, Racine, Walworth, Washington, and Waukesha Counties.

Plan Provider Network Changes

  • Unity-Community added dentists to Dodge, Iowa, and Jefferson counties, thus newly qualifying for State employees in these counties.
  • Touchpoint newly qualifies in Fond du Lac, Manitowoc, Marinette, and Sheboygan counties; and lost qualification in Winnebago County.
  • GHC Eau Claire newly qualifies in Rusk County.
  • Atrium newly qualifies in Ashland, Dunn, and Jackson Counties.
  • Humana-Western newly qualifies in Trempeleau County.
  • Prevea newly qualifies in Oconto County.
  • Gundersen Lutheran will discontinue dental benefits for 2004.

The SMP replaces CompcareBlue North in many northern counties.

Visit our Web site to view a map with plans listed by county.

No Plan name changes

Notable Changes to Uniform Benefits for 2004

  • Effective January 1, 2004, a single Pharmacy Benefit Manager (PBM) will provide pharmacy benefits and services to all participants. Participants will receive an identification card from Navitus, which is separate from the ID card they get from their health plans. No separate enrollment application is required for the PBM.
  • For a complete list of uniform benefit changes, please visit our Web site at http://etf.wi.gov/notable_changes.pdf
  • Employees who participate in the Employee Reimbursement Account (ERA) will want to check the formulary on the Navitus Web site, www.navitushealth.com, to see what the copayment level is for their regular medications before they enroll in the ERA program. Keep in mind the out-of pocket maximums are applied only to Level 1 and Level 2 drugs. IRS regulations prohibit the reimbursement of insurance premiums through a medical expense reimbursement account.

General Information

Employees who want to continue participating in their current plans should do the following:

  • Verify that their current plans are available in their area for 2004.
  • Verify that selected physicians, clinics, and/or hospitals are still available under their plans in 2004.
  • 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 questions.

Employees must return completed applications to change plans to their employers no later than 4:30 p.m. on Friday, October 24, 2003.

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. SMP selection is based on county of residence. It's Your Choice booklets identify geographic areas covered by each plan.

DETF 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, 2004 or later, must complete applications as active employees. Changes in annuitant coverage will be handled by DETF when employees apply for annuitant benefits.

In the event an employee loses eligibility for coverage under their spouse's plan, or if their spouse's employer premium contribution ends for that plan, the employee has a special 30-day enrollment opportunity to become insured under the State Group Health Insurance Program without waiting periods for pre-existing conditions, if otherwise eligible.

* Remind employees to keep their 2004 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.

IMPORTANT NOTES:

  • Monthly premium rate sheets will not be bound into the 2004 It's Your Choice booklet. DETF will distribute separate rate sheets to employers at approximately the same time the booklets are distributed. Please insert a rate sheet in each booklet prior to distribution to employees.
  • Employees must contact the plans directly requesting verification or explanation of service area and/or provider availability related to Dual-Choice 2004.
  • When calling Navitus or a health plan, employees must identify themselves as a State of Wisconsin Plan employee in order to receive information pertinent to the Group Health Insurance Programs administered by DETF.
  • 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 DETF. Plans often report that 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, including information related to student status, which will enable dependents to continue their current health insurance.

Important Procedural Changes for the Submission of Health Insurance Applications

Why is DETF changing the Health Insurance Applications and Coverage Reports?

To ensure that the Pharmacy Benefit Manager (PBM) receives the most current information regarding employees enrolled in health insurance, the Department has changed the Group Health Insurance Application (ET-2301) and Group Health Insurance Application for Grad Students (ET-2302) in addition to health insurance coverage reporting.

What are the changes to the health insurance application?

DETF revised several fields on the health insurance applications to comply with federal Health Insurance Portability and Accountability Act (HIPAA) regulations. Please refer to Employer Bulletin Volume 20 No. 14 for further additional information on the federal provisions.

DETF changed the ply distribution order to:

  1. ETF Advance Copy
  2. Carrier Advance Copy
  3. Employer Copy
  4. ETF Coverage Report Copy
  5. Employee Copy

DETF will not distribute revised health insurance applications to employers along with the It's Your Choice booklets. You must order the revised health insurance applications immediately using one of the following methods:

  1. The Employer Section of DETF's Web site: http://etf.wi.gov
  2. DETF's self-service line 877-383-1888 (toll free) or 266-2323 (local)
  3. Filling out and returning the attached form to DETF.

What are the changes to the health application submission process?

  1. Send the ETF Advance Copy to the Department upon completion of the application.
  2. Send the Advance Carrier Copy to the appropriate health plan upon completion of the application.

    NOTE: For Dual-Choice, all carrier advance registration copies of the Dual-Choice applications must be sent to the plans by Friday, November 7, 2003.

  3. Retain the Employer Copy and give the employee copy to the employee.

What are the changes to the health insurance coverage report submission?

  1. The ETF Coverage Report Copy of the application will be attached to the Department's copy of the Coverage Report for the appropriate month.
  2. No application plies will be attached to the carrier copy of the Coverage Report.
  3. Send both sets to DETF as currently done.

NOTE: This is an important change–the Carrier Copy of the application no longer exists.

When are these changes effective?

Employers must begin using the revised health insurance applications for:

  • 2004 Dual-Choice
  • All other enrollments with coverage begin date of January 1, 2004, or later and reported on the January 2004 (or later) Additions Report.

Destroy any remaining old Health Insurance Application forms after you submit the December 2003 Coverage Reports (due November 20).

Does this new health application process change the way I handle other health insurance forms?

No. You should continue to send copies of Health Insurance Information Change (ET-2329), Group Health Insurance Transfer Reports (ET-1615), Group Health Insurance Cancellation Reports (ET-1616), and Medicare Eligibility Statements (ET-4307) directly to the health plans and to DETF upon completion of the forms as currently done. However, you may wish to include these forms when you mail the ETF Advance Copy to DETF and the Carrier Advance Copy to the health plans.

How should I submit the old applications for enrollments with coverage begin dates prior to January 1, 2004 (additions appearing on either the November 2003 or December 2003 Coverage Reports)?

This process will not change from the current process:

  1. Send the Carrier Advance Copy ply of the applications to the health plan upon completion of the application.
  2. Send the ETF Copy ply of the applications to DETF upon completionof the application.
  3. Attach the Carrier Copy ply of the applications to the carrier set of the November or December Coverage Reports.
  4. Retain Employer Copy ply and give Employee Copy ply to employee.

How should I submit the revised applications for enrollments with coverage begin dates prior to January 1, 2004 (additions appearing on either the November or December coverage reports)?

  1. Send the Carrier Advance Copy ply of the applications to the health plan upon completion of the application.Send the ETF Advance Copy ply of the applications to DETF upon completion of the application.
  2. Attach the ETF Coverage Report Copy ply of the applications to the carrier set of the November or December Coverage Reports.
  3. Retain Employer Copy ply and give Employee Copy ply to employee.

How should I submit the old applications for enrollments with coverage begin dates on or after January 1, 2004 (Dual-Choice and/or other additions appearing on the January or subsequent coverage reports)?

You must begin using the new applications for Dual-Choice and other enrollments with coverage begin dates of January 1, 2004 or later. However, if you use an old application in error for an enrollment beginning January 1, 2004 or later:

  1. Send the Carrier Advance Copy ply of the application to the health plan upon completion of the application.
  2. Send the ETF Copy ply of the application to DETF upon completion of the application.
  3. Attach the Carrier Copy ply of the application to DETF set of the January (or subsequent month) Coverage Reports.
  4. Retain Employer Copy ply and give Employee Copy ply to employee.How should I submit the revised applications for enrollments with coverage begin dates on or after January 1, 2004 (Dual-Choice and/or other additions appearing on the January or subsequent coverage reports)?
  5. Send the ETF Advance Copy ply of the application to DETF upon completion of the application.
  6. Send the Carrier Advance Copy ply of the application to the appropriate health plan upon completion of the application.
  7. Attach the ETF Coverage Report Copy ply to DETF copy of the Coverage Report for the appropriate month and send to DETF.
  8. Retain Employer Copy ply and give Employee Copy ply to employee.

Employer's Application Processing Instructions for Dual-Choice 2004

You must verify that the employee has completed the application in its entirety. If a Health Maintenance Organization 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.

Under the three-tier premium contribution structure, some plans will accept a clinic name in lieu of a physician. If the health plan does not accept an application with a clinic name, the employer is not responsible for obtaining this information. The plan will contact the subscriber directly. Most plans will require the name of a primary care physician. It is the employee's responsibility to fill in this box on the application.

Complete the Employer Portion of the application and provide the following information on each Dual-Choice 2004 Health Insurance Application:

  • Employer Identification Number (EIN)
  • Name of Employer
  • Payroll Representative Signature
  • Telephone Number
  • Group Number
  • Enrollment Type 40 for Dual-Choice; 43 for 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 of January 1, 2004
  • Prospective Date of Coverage of January 1, 2004

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 7, 2003. This approach will assist DETF in ensuring that your employees receive their new subscriber cards prior to January 1, 2004.

Each week, send the ETF Advance ply of Dual-Choice applications directly to DETF. All ETF Advance plies must be forwarded to DETF by November 7, 2003.

More detailed instructions explaining Coverage Report processing will be sent in November 2003.

Procedures for Withdrawing Dual-Choice Elections

Employees may rescind Dual-Choice elections by notifying their employers in writing prior to December 31, 2003. 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 DETF as soon as you receive the request.

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 403D 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 24, 2003. Also note that late Dual-Choice material can be submitted to DETF via Fax at (608) 266-5801.

Health Fairs

A DETF representative will be at the following health fairs to assist with employee questions. Please note that DETF staff may not be attending the entire time that is reserved for the health fair due to scheduling conflicts and/or travel time.

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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