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Employers

Department of Employee Trust Funds

State Agency Health Insurance Administration Manual

ET-1118, Rev. 1/2017


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 1Background Information (revised 9/2014)

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

Chapter 2 – Health Plan and Program Information (revised 12/2016)

  • 201 Alternate Health Plans (HMOs, PPOs, and HDHPs)
  • 202 Standard Plan
  • 203 State Maintenance Plan (SMP)
  • 204 Three Tier Health Insurance Program
  • 205 Contribution Rates
  • 206 Pharmacy Benefit Manager (PBM) - Navitus
  • 207 Health Plan Contacts
  • 208 Coordination of Benefits (COB)

Chapter 3 – Eligibility (revised 1/2017)

  • 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 (revised 1/2017)

  • 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 (revised 10/2015)

  • 501 Qualifying Events
  • 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
  • 507 Considerations When Both Spouses Are Employed by the State, the University of WI, or One or Both Are Annuitants
  • 508 Considerations When One Spouse is Employed by a Local Employer in the WPE Group Health Insurance Program or Other Non-State Employer

Chapter 6 – It’s Your Choice Open Enrollment (revised 12/2016)

  • 601 It’s Your Choice Open Enrollment
    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
    605 Late It’s Your Choice Review Sample Letter

Chapter 7– Leave of Absence (LOA) (revised 12/2016)

  • 701 Definition of a Leave of Absence
  • 702 Employer Contribution Toward Health Insurance Premium While on an Unpaid Leave of Absence
  • 703 Coverage During an Unpaid Leave of Absence (Non Military) - Coverage Does Not Lapse While on a Leave of Absence
  • 704 Coverage During an Unpaid Leave of Absence (Non Military) - Coverage Lapses While on a Leave of Absence
  • 705 Coverage During Military Leave of Absence
  • 706 Coverage During Layoff
  • 707 Coverage During Appeal of Discharge

Chapter 8 – Cancellation and Termination of Coverage (revised 12/2016)

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

Chapter 9 – COBRA, Continuation and Conversion (revised 9/2014)

  • 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 (revised 9/2014)

  • 1001 Coverage – Requirements to Continue
  • 1002 Coverage for Former State Employees Whose Coverage Lapsed
  • 1003 Premium Payment

Chapter 11 – Rehired Annuitants (revised 9/2014)

  • 1101 Eligibility
  • 1102 Coverage
  • 1103 Disability Annuitants

Chapter 12 – Accumulated Sick Leave Conversion Credits (ASLCC) (revised 9/2014)

  • 1201 Accumulated Sick Leave Conversion Credit Program
  • 1202 Eligibility
  • 1203 Unpaid Leave/Temporary Layoff
  • 1204 Permanent Layoff
  • 1205 Permanent Layoff Sick Leave Conversion Reference Chart
  • 1206 Accumulated Sick Leave and Chapter 40 Terminations
  • 1207 Certifying Credits through the Online Accumulated Sick Leave System (AcSL)
  • 1208 Generating a Sick Leave Credit Estimate through the Online Accumulated Sick Leave System (AcSL)
  • 1209 Escrow of Sick Leave Credits
  • 1210 Payment
  • 1211 Annual Statement of Account

Chapter 13 – Medicare (revised 9/2014)

  • 1301 Overview of Medicare

Chapter 14 – Employee Death (revised 9/2014)

  • 1401 How to Report an Employee Death
  • 1402 Surviving Spouse/Domestic Partner and Dependents
  • 1403 Surviving Spouse/Domestic Partner who is also an Employee Eligible for Coverage

Chapter 15 – Invoicing (revised 9/2014)

  • 1501 Viewing Your Invoice
  • 1502 Reconciling Your Invoice
  • 1503 Accepting and Paying Your Invoice
  • 1504 Late Interest Charge
  • 1505 Who to Contact for Assistance

Appendix A – Forms and Brochures (revised 9/2014)

Appendix B – Codes (revised 9/2014)

  • B-1. Employee Type Codes
  • B-2. Coverage Type Codes
  • B-3. Individual Relationship Codes
  • B-4. Health Plan Codes
  • B-5. High Deductible Health Plan (HDHP) Codes

Appendix C – myETF Benefits (revised 4/2015)

  • C-1 How to Log in to myETF Benefits
  • C-2 Add Coverage
  • C-3 Add Dependent
  • C-4 Remove 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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