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Employers

Wisconsin Retirement System

Local Health Insurance Administration Manual

ET-1144, Rev. 10/2015


The following chapters are in Adobe Acrobat PDF format.  To view, download or print these chapters, you will need the Acrobat Reader.  If you do not have Acrobat Reader installed on your system, you will need to install/download the free Acrobat Reader


TABLE OF CONTENTS

PREFACE

CHAPTER 1 -- BACKGROUND INFORMATION

  • 101 Applicable Policies, Statutes and Legislation
  • 102 Employer Agent Responsibilities
  • 103 Employer Training and Support
  • 104 myETF Benefits System (MEBS)
  • 105ETF Ombudsperson Services
  • 106 Employer Services Section (ESS) Contacts

CHAPTER 2 – HEALTH PLAN AND PROGRAM INFORMATION

  • 201 Alternate Health Plans (HMOs)
  • 202 Standard Plan
  • 203 State Maintenance Plan (SMP)
  • 204 Three Tiering Health Insurance Premium Structure
  • 205 Program Options (PO)
  • 206 Pharmacy Benefit Manager (PBM)
  • 207 Health Plan Contacts
  • 208 Coordination of Benefits (COB)

CHAPTER 3 – ELIGIBILITY

  • 301 Employee, Annuitant and Continuant Eligibility
  • 302 Dependent Coverage Eligibility
  • 303 Employer Premium Contribution Eligibility
  • 304 Determining Effective Dates for the Employer Premium Contribution
  • 305 WRS Previous Service Check

CHAPTER 4 – INITIAL ENROLLMENT

  • 401 Initial Enrollment and Effective Dates
  • 402 Declining Coverage
  • 403 Enrollment Opportunities for Employees who Previously Declined or Cancelled Coverage
  • 404 Applying for Coverage
  • 405 Insurance Cards

CHAPTER 5 – CHANGING COVERAGE

  • 501 Status Changes
  • 502 Changing Plans Due to a Residential Move
  • 503 Changing from Single to Family Coverage
  • 504 Changing from Family to Single Coverage
  • 505 Adding Dependents
  • 506 Removing Dependents

CHAPTER 6 – IT'S YOUR CHOICE OPEN ENROLLMENT

  • 601 It’s Your Choice Open Enrollment Eligibility
  • 602 Withdrawing/Rescinding It’s Your Choice Enrollment Elections
  • 603 When a Health Plan is Not Available at It’s Your Choice
  • 604 Late It’s Your Choice Applications

CHAPTER 7 – LEAVE OF ABSENCE

  • 701 Definition of a Leave of Absence
  • 702 Coverage Does Not Lapse While on a Leave of Absence
  • 703 Coverage Lapses While on a Leave of Absence
  • 704 Coverage During Layoff
  • 705 Coverage During Appeal of Discharge

CHAPTER 8 – CANCELLATION AND TERMINATION OF COVERAGE

  • 801 Ending Coverage
  • 802 Changing From Active to Annuitant Coverage
  • 803 Cancellation of Coverage

CHAPTER 9 – COBRA, CONTINUATION AND CONVERSION

  • 901 Overview of COBRA, Continuation and Conversion
  • 902 Persons Eligible for Continuation (Qualified Beneficiaries)
  • 903 Employee Responsibilities
  • 904 Qualified Beneficiary Responsibilities
  • 905 Employer Responsibilities
  • 906 Notice Requirement Illustration Chart
  • 907 Continuation Coverage Information

CHAPTER 10 – RETIREMENT, DISABILITY OR LONG-TERM DISABILITY INSURANCE

  • 1001 Coverage – Requirements to Continue
  • 1002 Medicare Enrollment
  • 1003 Premium Payment
  • 1004 Completing Employer Verification of Health Insurance Coverage (ET-4814)

CHAPTER 11 – REHIRED ANNUITANTS

  • 1101 Eligibility
  • 1102 Coverage
  • 1103 Disability Annuitants

CHAPTER 12 – MEDICARE

  • 1201 Overview of Medicare

CHAPTER 13 – EMPLOYEE DEATH

  • 1301 How to Report an Employee Death
  • 1302 Surviving Spouse/Domestic Partner and Dependents
  • 1303 Surviving Spouse/Domestic Partner who is also an Employee Eligible for Coverage

CHAPTER 14 – INVOICING

  • 1401 Viewing Your Invoice
  • 1402 Reconciling Your Invoice
  • 1403 Accepting and Paying Your Invoice - Automated Clearing House (ACH)
  • 1404 Late Interest Charge
  • 1405 Who to Contact for Assistance

APPENDIX A – FORMS AND BROCHURES

APPENDIX B – CODES

  • B-1 Employee Type Codes
  • B-2 Coverage Type Codes
  • B-3 AIndividual Relationship Codes
  • B-4 Enrollment Type Codes
  • B-5 Program Option Codes
  • B-6 Surcharge Codes
  • B-7 Health Plan Codes

APPENDIX C – myETF BENEFITS

  • C-1 How to Log in to myETF Benefits
  • C-2 Add Coverage
  • C-3 Add Dependent
  • C-4Remove Dependent
  • C-5 Change Health Plans
  • C-6 Termination of Coverage
  • C-7 Pending Transactions
  • C-8 Enrollment Inquiry
  • C-9 Dependent Inquiry
  • C-10 Address Inquiry
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