Employer Bulletin
State Agencies
Vol. 22, State I
October 14, 2005
- Plans Mail Annual Dependent Status Letters and Questionnaires
- Pharmacy Benefit Manager (PBM) ID Card Reminder
- It’s Your Choice Booklet Corrections/Updates
The Department of Employee Trust Funds (ETF) requires that participating
health plans annually send the attached
letter and questionnaire to subscribers with dependents age
19 or older. This year, participating health plans will begin mailing
questionnaires to subscribers the week of October 24. The deadline
to return them to the health plan is December 9, 2005. Health plans
must receive questionnaires by this date in order to ensure that
coverage will continue on January 1, 2006. If Health Plans receive
the Student/Disabled Dependent Status questionnaire later than December
9, the dependent’s health insurance coverage may end as of
December 31, 2005.
Note: Health plans are not allowed to accept verbal responses
to the student/disabled dependent status questionnaire.
Subscribers switching health plans during the 2006 Dual-Choice
enrollment period must complete and return the dependent status
questionnaire to the health plan that initiated the letter, not
the health plan selected for 2006. ETF will notify the new health
plan (the subscriber’s Dual-Choice selection) of any dependent
status changes based on the questionnaire. Subscribers covered by
CompcareBlue Northeast in 2005 must return the student/disabled
dependent status questionnaires to CompcareBlue Northeast even though
the health plan will no longer be available in 2006.
Health Plans will notify ETF of terminated dependents on
January 3, 2006. Subscribers’ failure to complete
and return the student/disabled dependent status questionnaire may
result in denied/delayed claims and prescription drug benefits for
dependents.
ETF will notify employers of terminated dependents the
week of January 9, 2006. Employers will receive a report,
compiled from the data submitted by the health plans, notifying
them of their subscribers’ terminated dependents.
For changes from family to single coverage resulting from a change
in student/disabled dependent status, employers must:
- Request a Health Insurance Application (ET-2301) from any subscriber
changing from family to single coverage, and
- Issue a Continuation/Conversion Notice (ET-2311) to previously
covered dependent(s).
In the event family coverage remains in force following removal
of a student/disabled dependent from coverage, employers must:
Dependent Reinstatement
In the event a dependent is terminated due to non-response to
the health plan’s questionnaire, coverage can be reinstated
back to the date of termination by submission of one type of documentation
of student status and a Health
Insurance Information Change form (ET-2329) to ETF. Examples
of types of documentation include:
- Current class schedule
- Completed Student Status Letter
- Letter from the educational institution indicating the dependent
is a full-time student for the current semester
- Copy of a payment receipt from the educational institution for
the current semester. The receipt must indicate the total class
credits taken.
Reminder: Pharmacy Benefit Manager (Navitus) ID Cards
The program’s pharmacy benefit manager (PBM), Navitus Health
Solutions, will send new identification (ID) cards to subscribers
only when one or more of the following information changes occur:
- New health plan selected, including selections made during Dual-Choice
- Dependent(s) added or deleted
- Group number change
- Name change
Subscribers without any of the changes noted above should continue
to use their existing Navitus ID card. Subscribers can request additional
copies of their ID card by contacting Navitus customer service at:
Navitus Health Solutions
5 Innovation Court
Appleton, WI 54912
Phone: (toll free) 866-333-2757
www.navitushealth.com
Please contact the Employer Communication Center at (608) 264-7900
with questions regarding the Student/Disabled Dependent Status Questionnaire
or the PBM ID cards.
It’s Your Choice Booklet Corrections/Updates
Please note the following corrections/updates to the 2006 It’s
Your Choice booklets. ETF strives to provide the most complete and
accurate information possible so that subscribers can make informed
health insurance coverage decisions. We apologize for any inconvenience
these changes may cause.
Subscribers wanting additional information regarding benefits and
participating providers should contact the health plan or PBM. (health
plan contact information)
Corrections to all It’s Your Choice booklets:
- On page D-2, Changes to Uniform Benefits, the table states that
the 2005 Emergency Room copay is $50. It is currently $40 (but
will increase to $60 in 2006).
- The “Hospitals in County” list on the Plan Description
Page for CompcareBlue Southeast (Section G), Kenosha County, should
include St. Catherine’s Hospital and Kenosha Hospital. They
are in-network providers.
- The Plan Description Page for Humana Eastern (Section G), dental
benefits information, lists an incorrect Internet site address.
It should read http://www.humanadental.com.
Also, some members are having trouble connecting to Humana Eastern
and Humana Western’s online provider directory. You may
also use http://www.humana.com
to locate in-network providers.
- The Plan Description Page for UnitedHealthCare Southeast (Section
G) should list Racine County providers; this health plan is qualified
in this county.
- On the How to Contact the Health Plans page (inside back cover),
the WPS Prevea Health Plan Internet mail address should read http://wpspreveahealthplan.com.
Corrections to the State
Employee (ET-2107) and Graduate
Assistant (ET-2127) booklets only:
- On the Notable Plan and Program Changes (pages i and ii), we
direct employees to send health insurance application forms to
the Department of Employee Trust Funds. THIS IS INCORRECT. Employees
must give their forms to their benefits/payroll/human resources
office.
- The Health Plan Options and Tiering By County Chart on page
A-11 refers to Sheboygan County. UnitedHealthCare NE is a health
plan option for that county; UnitedHealthCare SE is not. The map
on page A-5 is correct.
- The Plan Description Page for the State Maintenance Plan (SMP)
(Section G) under Marathon County should include Marshfield Clinic
providers under the heading of Major Providers in County.
Corrections to the Annuitant/Continuant
booklet (ET-2108) only:
- See the grid that explains map codes on page A-2. CompcareBlue
Southeast should be noted as CS (not NS) and Dean Health Plan
should be noted as D (not C). The map on page A-3 is correct.
- See the “additional information for persons on Medicare”
box at the bottom of the rate table on page A-4. Members interested
in Medicare Plus $1,000,000 information should see pages G-56
and G-57.
- See the sentence at the bottom of page C-18 (which continues
to page C-19). It should read, “If the surviving dependents
terminate coverage for any reason they may not re-enroll later.”
- The Plan Description Page for the State Maintenance Plan (SMP)
(page G-39) under Marathon County should include Marshfield Clinic
providers under the heading of Major Providers in County.
- Page G-54 is a duplicate of page G-48. Please disregard.
UnitedHealthcare Provider Directory
- UnitedHealthcare printed one combined provider directory for
both UnitedHealthcare SE and UnitedHealthcare NE networks. ETF
requires a separate provider directory for each plan. UnitedHealthcare
is working to publish new directories as soon as possible. Subscribers,
as well as employers who received a UnitedHealthcare directory
at the Dual-Choice Kick Off meeting on October 6, may request
a corrected directory by calling UnitedHealthcare Customer Service
at 1-800-357-0974.
GHC Eau Claire Clinics
Subscribers with questions regarding applications, eligibility,
enrollment, and general information should contact ETF (toll-free)
at 1-877-533-5020 or (608) 266-3285 (local Madison).
Employers with questions regarding applications, eligibility, enrollment,
and general information should contact the Employer Communication
Center at (608) 264-7900.
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