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Employers

Employer Bulletin

All State Agencies
Vol. 22, State F
September 16, 2005

Health Insurance Dual-Choice Information

Dual-Choice Enrollment Period is October 10-28, 2005

October 10-28, 2005, is the Dual-Choice Enrollment period for coverage effective January 1, 2006. Dual-Choice provides an opportunity for insured subscribers (active employees, annuitants, and former employees who have continued their coverage) to change health plans and/or change from single to family coverage without a waiting period for pre-existing conditions.

During the week of October 3, the 2006 It’s Your Choice booklets will be supplied to all State agencies for distribution to employees. That same week, the booklet will also be available on the Department of Employee Trust Funds (ETF) Internet site at http://etf.wi.gov. Additional information about the State Group Health Insurance Program and other insurance programs administered by ETF is also available on this site.

In November, you will receive an Employer Bulletin containing additional Dual-Choice reporting instructions. ETF will send the monthly health insurance reporting forms for calendar year 2006 during the second week of November 2005.

Dual-Choice Kick-off Meeting Reminder

The annual Dual-Choice Kick-off meeting is set for Thursday, October 6, 2005, from 9:00 a.m. to 11:30 a.m. at the Rodeway Inn (former Quality Inn South), 4916 East Broadway, Madison, Wisconsin. Pre-registration is not required. Attendees may purchase coffee, other beverages, and pastries at the site.

The meeting provides an opportunity to receive information from health plans, pharmacy benefit manager (PBM) representatives, and ETF employees regarding health insurance program changes set to take place effective January 1, 2006. Please call the Employer Communication Center at (608) 264-7900 with questions.

No Dual-Choice Education Teleconference

The Wisconsin Coalition of Annuitants, UW-Extension and ETF will not hold a Dual-Choice education teleconference this year.

Notable Plan and Program Changes

1. Medicare Part D Information

Information regarding this coverage is available in the 2006 It’s Your Choice booklet, under Questions and Answers, Section C, numbers 69, 70, and 71. The Certificate of Creditable Coverage appears in Section B. ETF will mail additional information to employers and Medicare participants in the coming weeks.

2. Plans No Longer Available

  • CompcareBlue Northeast (suffix .14) will no longer be available as of January 1, 2006. Subscribers enrolled in this health plan must select another health plan for 2006. CompcareBlue Northeast will notify current subscribers of the change. In the event a subscriber fails to submit a new application during Dual-Choice, an application will have to be obtained for coverage under the Standard Plan.
  • Atrium Health Plan has merged with CompcareBlue Northwest. The acquisition was announced after portions of the 2006 It’s Your Choice booklet were printed. Please disregard references in the booklet to Atrium Health Plan. CompcareBlue Northwest will produce new identification cards and mail out information regarding referral and prior authorization procedures to Atrium Health Plan members prior to Dual Choice. Atrium subscribers who do not file an application during Dual Choice will automatically be enrolled in CompcareBlue Northwest. Subscribers with questions or concerns should contact CompcareBlue Northwest at the phone number listed on the inside back cover of the 2006 It’s Your Choice booklet.

3. New Plans Available

WPS Patient Choice Plan 1 (suffix .81) and WPS Patient Choice Plan 2 (suffix .82) will be available as of January 1, 2006. WPS Patient Choice Plans are located in Milwaukee, Ozaukee, Washington and Waukesha counties and are insured by WPS Health Insurance (WPS). WPS Patient Choice Plan 2 is also available in Racine county. These Preferred Provider Plans (PPP) have different networks and offer Uniform Benefits for in-network services. For more information, contact WPS at the telephone number and address listed on the inside back cover of the 2006 It’s Your Choice booklet.

4. Plan Name Change

Prevea Health Plan has been acquired by WPS. The new health plan name is WPS Prevea Health Plan (suffix remains .47). Current Prevea subscribers who wish to continue under WPS Prevea Health Plan do not need to file a Dual-Choice application. WPS Prevea will produce new identification cards in the future. However, current Prevea ID cards will be accepted by WPS Prevea providers. WPS Prevea will mail out information regarding provider network changes to current members prior to Dual-Choice. For more information, contact WPS Prevea at the telephone number and address listed on the inside back cover of the 2006 It’s Your Choice booklet.

5. Plan Provider Network Changes

  • A number of health plans have changed their service areas; some have made significant network changes. Please refer to the map on page A-3 and Plan Descriptions in Section G of the 2006 It’s Your Choice booklet. It is important that your covered employees verify with their health plan that their provider(s) will be available in 2006.

    Note: Health plans are required to provide current subscribers with a list of all plan providers that will not be available in 2006. Employees should contact their health plan and request this information if this list is not received by October 7, 2005.

  • State Maintenance Plan (SMP) will be newly available in Ashland, Burnett, Buffalo, Douglas, Marinette, Pepin, Pierce, Polk, St. Croix, Sawyer and Washburn Counties. Employees must live in a SMP county to be eligible to enroll in SMP.
  • UnitedHealthcare of Wisconsin Southeast (suffix .83) is a new service area in Milwaukee, Ozaukee, Racine, Walworth, Washington, and Waukesha Counties. Employees must file an application during Dual Choice to select this health plan.
  • United Healthcare (suffix .94) is now United Healthcare – Northeast.
  • Unity-Community has significantly reduced its provider network in Juneau County and is no longer qualified.

6. Change of Administrator for Standard Plan, SMP and Medicare Plus $1,000,000

The administration of these plans is changing to WPS Health Insurance (WPS) from Blue Cross & Blue Shield of Wisconsin (BCBSWI). Plan members will receive information this fall and early winter from:

  • WPS—Explanatory literature and later, new identification cards and booklets.
  • BCBSWI—Request for information on status of student or disabled dependent to members with dependents over age 19. Employees should return this information to BCBSWI.

7. Notable Changes to Uniform Benefits for 2006

See page D-2 of the 2006 It’s Your Choice booklet for a description of notable changes and clarifications.

8. Changes to Dental Coverage

See section G, Plan Description Pages of the 2006 It’s Your Choice booklet for more information or contact the health plan directly.

  • Dean Health Plan is implementing an in-network and out-of-network benefit.
  • Health Tradition will include coverage for crowns, dentures and bridges under their current $500 annual maximum.
  • Humana is implementing a $25 single/$75 family deductible.
  • Group Health Cooperative-Eau Claire is adding limited orthodontia coverage.
  • Physicians Plus will cover dental-appropriate “non-covered” services such as bridges and third dental exams at 50% up to $250 per year.
  • Unity Community will offer limited basic restorative and orthodontia coverage.
  • WPS Patient Choice Plan 1 and Plan 2 offer dental coverage.

9. Information on Provider Quality

Leapfrog, CheckPoint and Healthclick Wisconsin: The Group Insurance Board supports the goals of improving the quality and safety of health care services. The Leapfrog Group, CheckPoint and Healthclick Wisconsin gather information from Wisconsin hospitals on their efforts to adopt and enhance safety of health care services. The Leapfrog Group, CheckPoint and Healthclick Wisconsin gather information from Wisconsin hospitals on their efforts to adopt and enhance safety practices and standards proven to reduce medical errors and save lives. The Questions and Answers in Section C and Plan Descriptions in Section G of the 2006 It’s Your Choice booklet have additional information about hospitals that reported information to these organizations. Subscribers can visit the results online at www.leapfroggroup.org, www.wicheckpoint.org and www.healthclickwisconsin.org. By providing this information, ETF recognizes hospitals making improvements in patient safety and quality.

General Dual Choice Information

Employees wishing to continue participation in their current health plans should do the following:

  • Verify that their current health plans will be available in their area for 2006.
  • Verify that selected physicians, clinics, and/or hospitals will still be available under their health plans in 2006.
  • Review changes in benefits by reading the “Notable Plan and Program Changes” section, as well as the individual health plan descriptions, found in the 2006 It’s Your Choice booklet.
  • Call the health plan directly with specific benefit or provider questions.

To change health plans or coverage levels, employees must return completed health insurance applications to their employers no later than 4:30 p.m. on Friday, October 28, 2005.

Employees may select any alternate health plan (i.e., HMO) 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. The 2006 It’s Your Choice booklet identifies geographic areas covered by each health plan.

ETF mails It’s Your Choice booklets, complete with special application forms, directly to retirees and former employees who have continued their health insurance coverage. Employees who wish to change health plans and who will retire effective January 1, 2006, or later, must complete their Dual-Choice applications as active employees. Changes in annuitant coverage are handled by ETF when the employee applies for annuitant benefits.

An employee eligible for the State Group Health Insurance Program but covered under a spouse’s plan, who loses eligibility for coverage under that plan, has a special 30-day enrollment opportunity to become insured under the State Group Health Insurance Program without waiting periods for pre-existing conditions. This same enrollment opportunity exists for an employee covered under a spouse’s plan in the event the spouse’s employer premium contribution ends.

Booklet Distribution

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

  1. Insured employees who have indicated they do not wish to make a change during Dual-Choice. Please remind these employees that they remain responsible for understanding the information contained in the It’s Your Choice booklet and that the booklet serves as their certificate of coverage if enrolled in an alternate health plan (i.e., Health Maintenance Organization).
  2. Insured employees on temporary layoff, those on permanent layoff paying premiums via sick leave through the employer, or leave of absence. Employees who allowed health insurance coverage to lapse while on a leave of absence or a temporary layoff that encompassed the entire Dual-Choice enrollment period should be advised that they are eligible to make a Dual-Choice election within 30 days of returning from the leave or layoff.

    Note: Remind employees to keep the 2006 It’s Your Choice booklet as a reference for the entire plan year.

ETF does not distribute Health Insurance Applications (ET-2301) to employers along with copies of the It’s Your Choice booklets. To request applications:

  • Complete the Online Forms Order page found under “Employers” at http://etf.wi.gov. OR
  • Contact ETF Supply and Mail Services 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 related.

Employees must contact health plans directly to request the most up-to-date information regarding service area and/or provider availability related to Dual-Choice 2006.

Note: When calling Navitus or a health plan, employees must identify themselves as a State of Wisconsin Plan subscriber in order to receive information pertinent to the Group Health Insurance Program administered by ETF.

Health plans often report they are unable to contact current subscribers due to incorrect addresses on file. Please remind employees who participate in the Group Health Insurance Program that they are responsible for providing address changes and revisions of other relevant information to you via the Health Insurance Information Change form (ET-2329). Employers are responsible for routing information change forms to ETF and the health plans. Once mailing addresses are updated, employees will receive provider information in a timely fashion, including information related to the annual student status verification process, which enables dependents who remain eligible in 2006 to continue their current health insurance.

Employer’s Application Processing Instructions for Dual-Choice 2006

  1. Verify that the employee has completed the application in its entirety. If an HMO is selected, a physician/clinic name and the county in which the physician provides services must be entered on the application.

    Some health plans will accept a clinic name in lieu of a physician. Should a health plan not accept an application with a clinic name, the employer is not responsible for obtaining this information. The health plan will contact the subscriber directly. Most health plans require the name of a primary care physician. It is the employee’s responsibility to fill in this box on the application.

  2. Complete the Employer Portion of the application and provide the following information on each Dual-Choice 2006 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
  • 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 – Leave Blank
  • Prospective Date of Coverage of January 1, 2006
  1. Separate each type of application (ET-2301 and ET-2302 for UW Graduate Assistants).
  2. Send the Advanced Carrier Registration Copy of Dual-Choice applications directly to the health plans on a weekly basis. All Advanced Carrier plies must be forwarded to the health plans by November 11, 2005. This approach will assist ETF in ensuring that your employees receive their new subscriber cards prior to January 1, 2006.
  3. Send the ETF Advance ply of Dual-Choice applications directly to ETF on a weekly basis. All ETF Advance plies must be forwarded to ETF by November 11, 2005.

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

Procedures for Withdrawing Dual-Choice Elections

Employees may rescind 2006 Dual-Choice elections by notifying their employers in writing prior to December 31, 2005. The written request should be filed with the employee’s records. When you receive a request to rescind, make four copies of your ply of the Dual-Choice application initially submitted by the employee to select a change and write “Rescind” across each copy. Forward one copy to the current health plan, one copy to the health plan indicated as “Plan Selected,” and one copy to ETF as soon as you receive the request. Retain a copy for your records.

Additional Dual-Choice Instructions

Specific Dual-Choice instructions are found in Chapter 4 of your Group Health Insurance Employer Administration Manual.

  • Refer to Subchapter 403D if you have an employee initially eligible for coverage in November or December 2005, or who terminates employment in November or December 2005.
  • Refer to Subchapters 406 and 407 for the procedure to follow if you receive a Dual-Choice application after October 28, 2005. 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.

Plan Alternate Dual-Choice Application Mailing Addresses

Most health plans request that Dual-Choice applications be sent to the respective address listed on the inside back cover of the 2006 It’s Your Choice book. However, to ensure timely processing, the following health plans require Dual-Choice applications be sent to their alternate address as listed below:

Group Health Cooperative-South Central:
Attn: GHC Enrollment Department
GHC SC
1265 John Q. Hammons Dr.
PO Box 44971
Madison WI 53744-4971

Humana:
Attn: Maria Chumley - 6th Floor
Humana Enrollment
101 East Main Street
Louisville KY 40202

Network Health Plan:
Use address in It’s Your Choice book;
mark “Group Administration” on envelope.

 

Bulletin Attachments:

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