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Wisconsin Department of Employee Trust Funds
Wisconsin Department of Employee Trust Funds
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Wisconsin Department of Employee Trust Funds

Itís Your Choice 2019 Kickoff Meeting
Recordings & Questions and Answers

Employers

Click on the category/topic below to expand the questions.

View 2019 State Employer Kickoff Meeting Recording

Download the 2019 State Employer IYC Kickoff Slide Presentation


Is the August 30, 2018, version of the ET-2301 Health Insurance Application/Change form the most recent version, and should it be used for 2019 open enrollment if a paper application is used/required?

Yes. The ET-2301 Health Insurance Application/Change form is final and posted on ETF’s website.

There is now an application/change form for active employees (ET-2301) and one for retirees (ET-2331). Which form should be used for COBRA continuants?

Either form ET-2301 Health Insurance Application/Change form or ET-2331 Health Insurance Application/Change for Retirees & COBRA Continuants form may be completed. COBRA information is included on both forms.

Regarding health plan ratings – who are they rated by?

The health plans are rated by ETF on an annual basis using data from the standardized Health Plan Employer Data and Information Set (HEDIS) and the Consumer Assessment of Health Plans (CAHPs) survey. The methodology for health plan ratings is available on the ETF website under the Health Benefits tab in the Report Cards section under the Health Plans heading.

If there are two separately-covered subscribers who have added their two children on both health plans, how do employers choose which employee’s plan they should be on? A court order states the children must be on both plans.

No double coverage is allowed. A court order does not change the eligibility requirements of our program. A child can switch from one plan to another if the child moves between parents or if the custody order changes. Employees will continue to have the opportunity to decide which plan should cover the child(ren). ETF will send a letter and if the parents do not respond within 30 days, ETF will assign coverage to the parent with the earlier month/day birthdate in the calendar year. The parents will be notified of this and have a 30-day opportunity to change the coverage to the other parent’s plan. Example: Mom's birthday is April 15 and Dad's is July 20. Coverage will be assigned to Mom, since her birthday falls first in the calendar year.

Is the change in documentation for single mothers effective now or January 1, 2019?

The change to require birth certificates following birth in order to add a dependent is effective January 1, 2019.

Does the documentation requirement for single parents also apply to new hires or just when there is a birth event?

The documentation requirement applies whenever a child is added to a single member’s plan, either at birth, upon hire, or due to a life event if the child was not previously covered.

What was the reason for the change to require single mothers to provide documentation when adding a child to their plan?

The change was made to address an equity issue. Single mothers and single fathers are both now required to provide documentation when adding a child to their plan for any reason.

If a person is hired on the first of the month and they select immediate coverage for health insurance, when is their health coverage effective?

If a new employee is hired on the first of the month and submits an application within 30 days of their hire date and selects immediate coverage, they will have coverage effective on the first. For example, if an employee is hired on September 1 and they submit an application with immediate coverage selected on September 26, their coverage will be effective on September 1.

To qualify for the lower Tier 2 Access Plan premium, do employees need to live and work out of state, or only live out of state?

Employees need to live and work out of the state to qualify for the lower premium.

To enroll in Medicare Advantage offered by UnitedHealthcare, does the participant’s physical address need to be in the continental United States?

The participant’s physical address must be in the United States or territories. Medicare retirees who live in a different country may want to choose Medicare Plus since coverage is provided outside of the country.

 

Is there a disclaimer with ALEX regarding the high number of High Deductible Health Plan (HDHP) recommendations it gives to employees?

Please see the Health Plan FAQ at www.etf.wi.gov/ALEX. This section includes information about the HDHP and explains that an HDHP is not for everyone. There are also general disclaimers on the launch screens.

Does the 2019 version of ALEX discuss/mention anything about vision benefits included in Uniform Benefits?

It does not. We can consider that in the future. In general, Uniform Benefits only covers an annual eye exam at a $25 copay and limited benefits related to medical conditions.

Why does ALEX not ask if the subscriber has Medicare or supplemental/secondary insurance?

ETF will look into this for the future. It does state on the landing page that ALEX is not for Medicare retirees.

Is ALEX only in English?

Yes, for now. There may be Spanish or other languages in the future.

 

What is the Health Care Flexible Spending Account (FSA) amount for plan year 2019?

The IRS has not yet posted Health Care FSA limits for 2019. ETF will continue to use the 2018 annual contribution limit of $2,650 for 2019. If the IRS should significantly increase the annual contribution limit for 2019, ETF will consider a limit increase.

 

Is there a public-facing website for Navitus to check drug costs, or is an account required?

The public-facing website for Navitus is available at www.etf.benefits.navitus.com.

Links to this website are available on the 2019 It’s Your Choice web pages under the “Health Benefits” tab, in the “Breakdown of Your Costs by Plan Design” section for Employee/COBRA/Retiree without Medicare. Scroll to the bottom of the page, to the Additional Prescription Drug Benefit Info section, and click on Prescription Drug Formulary or Prior Authorization Requirements where links can be found.

In the IYC booklet, on the chart depicting differences between co-insurance and HDHP, the drug coverage information does not appear to be split between the IYC Health Plan and HDHP. It appears that the HDHP has drug copays, when participants in the HDHP pay the entire cost of the drug. Why is the chart like this?

The explanation that the deductible must be met before plan coverage begins (i.e. copayments and coinsurance) is stated in the Prescription Deductible row, which is the row directly above the Prescription Copay amounts. More information about this topic and how it works is directly explained in ALEX.

 

If your health plan is not a State group health plan, and you are a dependent under a spouse with insurance offered by a Local employer (spouse is a Local employee), can you combine Uniform Dental Benefits from the spouse (Local employee) and Delta Dental supplemental coverage from the State?

Yes.

If an employee terminates/retires in November or December 2018 and they have supplemental benefits through Anthem or Epic, is COBRA coverage provided?

If an employee with supplemental dental coverage leaves active State employment before the end of 2018, they should submit continuation paperwork to their 2018 supplement provider (Anthem or EPIC) and Delta Dental, who will be providing their continuation coverage starting January 1, 2019. Delta Dental will coordinate the transition with the former supplemental plan and the participant. Forms are available on the ETF website.

Are there waiting periods for the new Delta Dental or VSP offerings?

No, there are no waiting periods with VSP or Delta Dental.

Is Uniform Dental required to enroll in a supplemental dental offering?

No, Uniform Dental is not required to enroll in a supplemental dental offering.

What options are available to an individual that requires medically necessary dental cleanings four times per year?

Two cleaning per year are covered for most people. The Uniform Dental Benefit also includes an Evidence-Based Integrated Care Plan (EBICP). The EBICP covers additional services/cleanings for certain conditions. See details in the Uniform Dental Benefits Certificate of Coverage.

What is recommended for employees who are not enrolled in the State program for Uniform Benefits and Uniform Dental, but who want preventive dental coverage?

Employees can seek preventive coverage privately with Delta Dental or another dental insurance provider. They can also pay for preventive dental services out-of-pocket with a pre-tax savings account, such as a Health Care Flexible Spending Account (FSA) or a Health Savings Account (HSA - must be paired with an IYC HDHP).

If an employee does not enroll in the State health insurance program and select Uniform Dental, will any other preventive dental option be offered?

No. An employee must have State health insurance to enroll in Uniform Dental. Uniform Dental is the only preventive dental option offered.

Can employees enroll in both the Delta Dental Select Plan and Select Plus Plan? If so, which plan pays first?

An individual employee may only in enroll in one supplemental dental plan. Enrollment in both supplemental offerings is only possible if two married State employees each select a different supplemental plan (i.e. Spouse A enrolls in the Select Plan and Spouse B enrolls in the Select Plus Plan) and enroll as an employee + spouse or employee + family. The plan in which the subscribing member is enrolled would pay first.

However, it is not recommended for employees to enroll in both supplemental plans, as they cover largely the same supplemental services at different rates. The only exception is that the Select Plus Plan includes orthodontic coverage.

Note: If two married State employees each enroll in a different supplemental plan, any children would have coverage by both supplemental plans.

Erupted tooth extractions are now covered by Uniform Dental instead of Uniform Benefits. If an employee has wisdom teeth that need to be extracted, some of which are erupted and some of which are not, would the services be covered under Uniform Dental or Uniform Benefits?

Some of the services would likely be covered by Uniform Dental. It is common for wisdom teeth removal to be a combination of surgical and non-surgical extractions. If the procedure has both surgical and non-surgical extractions, then the claims should be filed with both the health plan and the Uniform Dental Benefit. If the member has a Delta supplemental plan, the supplemental plan would be billed last to coordinate benefit for the surgical extractions with the health plan. Work with Delta Dental and your health plan to coordinate before services are received. It is important to make sure the provider is in-network for both insurers.
 

ETF indicates that Accidental Death & Dismemberment (AD&D) is life event eligible for enrollment. STAR says AD&D is not life event eligible. Who is correct?

AD&D enrollment is life event eligible.

Will ETF accept late supplemental dental enrollments all year (2019) for those employees that previously had supplemental dental coverage through EPIC or Anthem?

ETF will not accept late supplemental dental enrollments after December 31, 2018. Applications received after December 31, 2018, will not be accepted unless the member experiences a qualified life change event. An employee can also submit a late application along with a written justification for why it is late. This is known as the “late IYC process.” These late submissions are evaluated on a case-by-case basis. They are not always approved.

Are paper applications required for all supplemental employee elections, both during open enrollment and a qualified life change event?

Paper applications for active employees/new hires/qualified life events have been emailed to all employers. During open enrollment active employees, who have access, should enroll through STAR or MyUW portal. Retirees and Continuants can enroll through ETF’s Delta Dental’s and VSP’s websites.

Now that we’re moving to one supplemental dental vendor, Delta Dental, is it anticipated they will be part of the IYC plan offering each year?

The Delta Dental supplemental dental contract is for one year (2019). We anticipate that Delta Dental will submit a proposal to continue as the supplemental dental vendor in 2020. Other supplemental dental vendors are anticipated to submit bids as well. The decision will be made by the Group Insurance Board.

Can employees move between supplemental dental plans each year?

Yes. Employees may change their supplemental dental plan enrollment during open enrollment and after qualified life change events.

Does Delta Dental have ongoing new hire materials available?

Yes. Delta Dental has new hire materials available on their website: www.deltadentalwi.com/state-of-wi

Are supplemental dental plan premiums collected pre-tax?

Yes, for active employees.

 

Are STAR agencies required to submit paper applications for the opt-out-stipend during the open enrollment period?

No. However, if requested, agencies must document the election, either with screen shots or paper applications submitted.

How does ETF wish to receive other health insurance information for coordination of benefits?

STAR agencies may enter other health insurance through STAR in 2019. The UW may enter other health insurance through Employee Self Service. Non-STAR agencies should provide other health insurance information through MEBS.

What is the status of the myETF rollout?

ETF’s vendor for developing myETF, Vitech Systems Group, stopped providing services related to the development of the new benefits administration system. This unexpected stoppage significantly affected development of myETF and, as a result, we will not roll out the new functionality as planned on January 1, 2019. When we have additional information, we will reach out to you. Employers do not need to take any steps at this time. While this development with the vendor is disappointing, we appreciate the hard work, time and resources you and your organization have devoted to the myETF project. If you have questions, send an email to your case manager.

As a new payroll benefits specialist, it would have been beneficial to have an employer decision guide with more detailed information.

ETF’s It’s Your Choice (IYC) website is a great resource. An updated employer manual is coming soon and will provide one-stop access to detailed information. The employer manual includes requirements, screenshots, step-by-step instructions, and links to forms.

 

View 2019 Local Employer Kickoff Meeting Recording

Download the 2019 Local Employer IYC Kickoff Slide Presentation

Please explain tiering. What determines tiers for plans and why do plans change each year?

Tiering is the result of a combination of several factors that are negotiated each year, including costs, changes in rates, provider access, and risks. ETF develops the tiers in conjunction with the Group Insurance Board’s actuary, Segal Consulting (Segal). Tier 1 plans meet all the provider access requirements and have provided lower premiums that meet the Tier 1 breakpoint, which is established by the actuary and based on all the participating plans premium bids. Conversely, Tier 3 plans have the highest premiums. All premium bids are risk-adjusted, meaning that if a plan had a year of extremely high claims when compared to the other plans – this is taken into account so that the plans can be compared fairly.

The tier development process begins when participating health plans submit preliminary rate bids to Segal each summer. Preliminary rate bids are based upon the plan’s expected costs to provide services in the next year. Plans separately submit aggregate claims data which Segal uses to calculate a renewal rate for the plan. If a health plan’s preliminary premium bid is higher than Segal’s calculation, plan is told how much they need to lower their premium bid in order to be considered Tier 1. Plans have an opportunity to justify their preliminary premium bids or change their bids as part of the negotiation process. Some plans choose not to lower their bids, opting to be a Tier 2 or 3 plan for the upcoming year.

Tiers are determined on annual basis and the tiering placement of individual health plans may change from year to year.

Concerned employees should review the competing plan’s provider networks. Providers appear in multiple networks, so employees may be able to change plans and continue to see some or all their current providers. This is especially true in more rural areas where most providers accept payment from multiple health plans. All plans’ provider directories are available through the It’s Your Choice webpages, or members may contact plans directly for a copy.

What does it mean for employees when a health care provider moves from Tier 1 to Tier 2?

It typically means their monthly premiums will increase. Tiers do not affect benefits.

 

Where are the 88% and 105% tables located on the ETF website?

The 88% and 105% tables can be found here: http://etf.wi.gov/news/ht-2019local-rates_emp.htm

How are the 88% employer contribution limits calculated?

The formula calculates 88% of Tier 1 Qualified Plans' Average Premium for each county. Qualified plans meet the program’s provider access requirements.

When the employer and employee are located in two different counties, how does that impact premium contributions and provider options?

The employer contributes an amount based typically on the 88% tables for their county. The employee pays the difference between that set contribution and the remainder (if any) for any plan. Employees may select any participating health plan.

If an employer opts to contribute less than the 88% calculation, are there other requirements that must be met? For example, 80% for all employees to ensure fairness.

Yes, the employer must contribute more than 50% for full-time and 25% for part-time employees. Employers can offer different contributions by class of employee (for example, police vs. administration, etc.). Generally, there should not be a class containing one individual.

 

Do employers have a requirement to notify retirees of the 2019 change allowing them to re-enroll?

No, employers are not required to notify retirees of the change. ETF is mailing a letter to retirees who cancelled their coverage within the last five years. The WRS news also includes a brief article to inform retirees.

Can employers offer a monetary incentive to employees who elect to decline health insurance?

Yes; ETF does not limit incentives offered by local employers.

Are Medicare plans only available to retirees or can active employees choose a Medicare plan for themselves and/or their spouse?

Active employees cannot choose a Medicare plan for themselves and/or their spouse until they retire. If the employee or their spouse enrolls in any part of Medicare, that coverage will be the secondary payor.  Note: the only exception is for employees and their spouses who are eligible for Medicare’s End Stage Renal Disease (ESRD) program. For more information, see Frequently Asked Question #2 under Medicare Information.

Single and family premiums don’t reduce until the employee retires, enrolls in Medicare, and Medicare pays primary for their claims.

Why does it appear that there is not much of a cost savings when comparing premiums between a traditional deductible plan and a High Deductible Health Plan (HDHP)?

The premiums between program options are based upon actuarial factors. In the development of the factors, the actuary considers, in part, how many members meet annual deductibles and out-of-pocket limits. Also, ETF’s HDHP has a high actuarial value.  

If there are two separately-covered subscribers who have added their two children on both health plans, how do employers choose which employee’s plan they should be on? A court order states the children must be on both plans.

No double coverage is allowed. A court order does not change the eligibility requirements of our program. A child can switch from one plan to another if the child moves between parents or if the custody order changes. Employees will continue to have the opportunity to decide which plan should cover the child(ren). ETF will send a letter and if the parents do not respond within 30 days, ETF will assign coverage to the parent with the earlier month/day birthdate in the calendar year. The parents will be notified of this and have a 30-day opportunity to change the coverage to the other parent’s plan. Example: Mom's birthday is April 15 and Dad's is July 20. Coverage will be assigned to Mom, since her birthday falls first in the calendar year.

 

Do gift cards earned for completing wellness activities have to be claimed for tax purposes?

Yes, based on expert guidance, ETF considers the wellness incentives as taxable and reports the names of incentive recipients and the amount of and date the incentive was issued to state and local employers on a biannual basis for processing.

 

What is the status of the myETF rollout?

ETF’s vendor for developing myETF, Vitech Systems Group, stopped providing services related to the development of the new benefits administration system. This unexpected stoppage significantly affected development of myETF and, as a result, we will not roll out the new functionality as planned on January 1, 2019. When we have additional information, we will reach out to you. Employers do not need to take any steps at this time. While this development with the vendor is disappointing, we appreciate the hard work, time and resources you and your organization have devoted to the myETF project. If you have questions, send an email to your case manager.