Employer Bulletin

State Agencies
Vol. 22, State K
November 30, 2005

2006 Group Health Insurance Reporting Forms: Note Change; Dual-Choice Due Dates; Alternate Report Requests; Reporting and Assembly of 2006 Health Reports

Notice of change in report distribution:

Enclosed with this bulletin:

• Enclosed are one copy of each of the following 2006 Group Health Insurance reporting forms and documents. In the past, multiple copies were provided.
• Twelve mailing labels for sending reports to the Department of Employee Trust Funds.

For monthly reporting during 2006, please:

1. Photocopy the forms. OR
2. View and print the following forms from our Internet site, http://etf.wi.gov.
• State Health Insurance Summary (ET-1608) Rev. 10/2005
• State Employees 2006 Monthly Coverage Report (ET-1607) Rev. 10/2005
• Monthly Additions Report (ET-2610) Rev. 11/2005
• Monthly Deletions Report (ET-2612) Rev. 11/2005
• Monthly Changes Report (ET-2614) Rev. 11/2005

It is critical to use the 2006 Summary and Monthly Coverage reports when reporting for 2006.

Destroy any Summary and Monthly Coverage reporting forms not labeled as 2006.

In addition to the 2006 monthly reports, please use the most recently revised enrollment and information change forms in Plan Year 2006:

• Group Health Insurance Application (ET- 2301) Rev. 7/2005
• Group Health Insurance Application (ET- 2302) Rev. 9/2004 (UW Grad Assistants only)
• Health Insurance Information Change (ET- 2329) Rev. 7/2005

For additional reporting forms or applications, contact ETF’s Supply and Mail Services Section at (608) 266-3302. Forms may also be downloaded or ordered from the Employers Section of our Internet site, http://etf.wi.gov.

Tips for Completing Health Insurance Applications and Corresponding Reports Throughout 2006

Enrollment applications, monthly reporting forms, and premium remittances must be complete and accurate to ensure proper and prompt health insurance coverage for your employees. In addition, statistics generated from the monthly data submitted by employers are used to track the movement of individuals between participating health plans and counties. This information is used in the rate setting process for the Group Health Insurance Program.

Subchapter 501 and 502 of the Health Insurance Employer Administration Manual (ET-1118, Rev. 1/97) provides information concerning the “Prospective Date of Coverage” entered on the Group Health Insurance Application (ET-2301 or ET-2302) and “Effective Date” entered on the Monthly Additions Report (ET-2610). Subchapter 507 provides information concerning effective dates of termination of coverage.

2006 Dual-Choice Due Dates and Reporting Instructions

The January 2006 Health Insurance Reports are due Tuesday, December 20, 2005. Employers are encouraged to submit the January 2006 reports as early as possible, given the volume of changes resulting from Dual-Choice.

Note: Do not divide the January transactions between Dual-Choice and “regular transactions.” Both Dual-Choice and regular (non-Dual-Choice) transactions must be combined on the State Employees 2006 Monthly Coverage Report (ET-1607), Monthly Additions Report (ET-2610), Monthly Deletions Report (ET-2612), and the Monthly Changes Report
(ET-2614).

January 2006 Health Insurance Reports will include:

1. Two copies of the completed State Health Insurance Summary - 2006 (ET-1608)
2. Corresponding State Employees 2006 Monthly Coverage Report (ET-1607) for each plan, indicating all of the contracts (Dual-Choice and regular) added and deleted for the coverage month of January 2006.
3. Two copies of the Monthly Additions Report (ET-2610), Monthly Deletions Report (ET-2612), Monthly Changes Report (ET-2614) on which regular monthly transactions and Dual-Choice transactions (enrollment Type Codes 40 and 43 titled “Dual-Choice”) are combined.
   • ETF Coverage Report plies of the Dual-Choice and the regular (non-Dual-Choice) applications must be attached to the corresponding Monthly Additions Report (ET-2610).

   NOTE: Each entry on the Monthly Additions Report (ET-2610) must indicate the carrier suffix number of the previous health plan (the employee’s current health plan). Do not substitute the name of the health plan for the health plan suffix number.

   • A Monthly Deletions Report (ET-2612) for each health plan, listing each employee leaving that health plan at year-end, must be submitted.

   NOTE: Each entry on the Monthly Deletions Report (ET-2612) must indicate the suffix number of the newly elected health plan. Do not substitute the name of the health plan for the carrier suffix number.

Alternate Reporting Requests

Written requests to use an alternate form of reporting or to deviate from completing/ assembling the reports in the manner described herein, must be submitted to ETF and must be approved in advance. Requests must include the alternate form(s) and/or alternate assembly method. Mail or e-mail your request to:

Ron Diehl
Division of Trust Finance & Employer Services
Department of Employee Trust Funds
P O Box 7931
Madison, WI 53707-7931
E-mail: ron.diehl@etf.state.wi.us

Assembly of all Health Insurance Reports for 2006 (Including January Dual-Choice Reporting)

Assemble your reports in the following order (resulting in two sets of reports in descending order, one set for ETF and one set for the carrier):

I. ETF Report Packet

State Health Insurance Summary - 2006 (ET-1608) - Attach WiSMART document(s) directly behind the Summary. Note: If paying by check, attach the check to front of the Summary. (Please see instructions above for additional requirements for the Dual-Choice reports.)

State Employees 2006 Monthly Coverage Report (ET-1607) - Attach one Monthly Coverage Report per health plan with contracts to report. Assemble in the order in which the plans are listed on the Monthly Coverage Report. (Please see instructions above for additional requirements for the Dual-Choice reports.

Attach corresponding Monthly Additions Report (ET-2610), Monthly Deletions Report (ET-2612), and the Monthly Changes Report (ET-2614), along with applications and other supporting documentation (stapled in the upper left corner), to the respective Monthly Coverage Report in the order listed below.

Monthly Additions Report (ET-2610). Assemble ETF Coverage Report plies of Group Health Insurance Application (ET-2301) and Group Health Insurance Application (ET-2302) in the order in which the specific subscriber information is listed on the Monthly Additions Report.

Monthly Deletions Report (ET-2612). Assemble any necessary supporting documents (i.e. Group Health Insurance Cancellation Reports [ET-1616], Group Health Insurance Transfer Reports [ET-1615]) in the order in which the specific subscriber information is listed on the Monthly Deletions Report.

Monthly Changes Report (ET-2614). Assemble ETF Coverage Report plies of Group Health Insurance Applications (ET-2301), Group Health Insurance Applications (ET-2302), and/or Medicare Eligibility Statement(s) (ET-4307) in the order in which the specific subscriber information is listed on the Monthly Changes Report.

II. Health Plan Report Packet (Carrier Copies)

Copy of State Employees 2006 Monthly Coverage Report (ET-1607). Attach one copy of the Monthly Coverage Report per health plan with contracts to the report. Assemble in the order in which the plans are listed on the Monthly Coverage Report. Attach the corresponding Monthly Additions Report (ET-2610), Monthly Deletions Report (ET-2612), and the Monthly Changes Report (ET-2614) in the order listed below.

1. Monthly Additions Report (ET-2610) – No supporting documentation attached.
2. Monthly Deletions Report (ET-2612) – No supporting documentation attached.
3. Monthly Changes Report (ET-2614) – No supporting documentation attached.

Mail both sets of reports to: Division of Trust Finance & Employer Services, Department of Employee Trust Funds, P.O. Box 7931, Madison, WI, 53707-7931.

For questions on the proper way to assemble your monthly health insurance reports, call Ron Diehl at (608) 266-2737 or e-mail ron.diehl@etf.state.wi.us.