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Department of Employee Trust Funds
State Agency Health Insurance Administration Manual
ET-1118, Rev. 9/2006
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TABLE OF CONTENTS
PREFACE
CHAPTER 1 -- GENERAL INFORMATION
- 101 Introduction
- 102 Employer Responsibilities
- 103 Health Insurance Portability and Accountability Act (HIPAA)
- 104 ETF Ombudsperson Services
- 105 Insurance Complaint Form (ET-2405)
- 106 Internet Address – http://etf.wi.gov
- 107 Administrative Offices
- 108 Employer Forms
CHAPTER 2 – HEALTH PLAN AND
PROGRAM INFORMATION
- 201 Alternate Health Plans (HMOs)
- 202 Standard Plan
- 203 State Maintenance Plan (SMP)
- 204 Three-Tier Health Insurance Program
- 205 Pharmacy Benefit Manager (PBM)
- 206 Health Plan Contacts
- 207 Coordination of Benefits (COB)
CHAPTER 3 – ELIGIBILITY,
INITIAL ENROLLMENT AND COVERAGE INFORMATION
- 301 Coverage Eligibility
- 302 State Premium Contribution Eligibility
- 303 Determining Effective Dates of State Premium Contribution
- 304 WRS Previous Service Check
- 305 WRS Previous Service Checks Form (ET-1715)
- 306 Initial Enrollment and Effective Dates
- 307 Declining Coverage
- 308 Enrollment Opportunities for Employees who Previously Declined/Cancelled
Coverage
- 309 Completing the Group Health Insurance Application (ET-2301;
Graduate Assistant, ET-2302)
- 310 Group Health Insurance Application (ET-2301)
- 311 Identification (ID) Cards
- 312 Coverage During Leave of Absence (Non-Military)
- 313 Coverage During Military Leave of Absence
- 314 Coverage During Layoff
- 315 Coverage During Appeal of Discharge
CHAPTER 4 – CHANGES TO COVERAGE
AND TERMINATIONS
- 401 Dual-Choice Enrollment
- 402 Withdrawing Dual-Choice Elections
- 403 When a Health Plan Is Not Available at Dual-Choice
- 404 Late Dual-Choice Applications
- 405 Dual-Choice Review Sample Letter
- 406 Switching Health Plans Following Residential Move
- 407 Adding Dependents
- 408 Deleting Dependents
- 409 Completing the Health Insurance Information Change Form
(ET-2329)
- 410 Health Insurance Information Change Form (ET-2329)
- 411 Terminating Coverage
- 412 Changing from Active to Annuitant Coverage
- 413 Voluntarily Canceling Coverage
- 414 Enrollment/Coverage Change Effective Date Reference Chart
CHAPTER 5 – MONTHLY REPORTING
- 501 Overview of Monthly Reports
- 502 Completing the Monthly Additions Report (ET-2610)
- 503 Completing the Monthly Deletions Report (ET-2612)
- 504 Completing the Monthly Changes Report (ET-2614)
- 505 Completing the Monthly Coverage Report (ET-1607)
- 506 Completing the Health Insurance Summary (ET-1608)
- 507 Assembly of Health Insurance Reports
- 508 Premium Remittance
- 509 Credits
CHAPTER 6 – COBRA, CONTINUATION
AND CONVERSION
- 601 Overview of COBRA, Continuation and Conversion
- 602 Persons Eligible for Continuation (Qualified Beneficiaries)
- 603 Employee Responsibilities
- 604 Qualified Beneficiary Responsibilities
- 605 Employer Responsibilities
- 606 Notice Requirement Illustration Chart
- 607 Continuation Coverage Information
- 608 Instructions on Completing the Continuation - Conversion
Notice (ET-2311)
- 609 Sample Continuation - Conversion Notice (ET-2311)
CHAPTER 7 – RETIREMENT, DISABILITY
OR LONG-TERM DISABILITY INSURANCE
- 701 Coverage – Requirements to Continue
- 702 Coverage for Former State Employees Whose Coverage Has
Lapsed
- 703 Medicare Enrollment
- 704 Premium Payment
CHAPTER 8 – ACCUMULATED SICK
LEAVE CONVERSION CREDITS
- 801 Accumulated Sick Leave Conversion Credit Program
- 802 Eligibility
- 803 Unpaid Leave
- 804 Permanent Layoff
- 805 Permanent Layoff Sick Leave Conversion Reference Chart
- 806 Accumulated Sick Leave and Chapter 40 Terminations
- 807 Completing Accumulated Leave Certification (ET-4306)
- 808 Sample Accumulated Leave Certification (ET-4306)
- 809 Escrow of Sick Leave Credits
- 810 Payment
- 811 Annual Statement of Account
CHAPTER 9 – REHIRED ANNUITANTS
- 901 Eligibility
- 902 Coverage
- 903 Disability Annuitants
CHAPTER 10 – EMPLOYEE DEATH
- 1001 Surviving Spouse and Dependents
- 1002 Surviving Spouse Who Is Also a State Employee Eligible
for Coverage
CHAPTER 11 – CODES
- 1101 County Codes
- 1102 Coverage Codes
- 1103 Employee Type Codes
- 1104 Enrollment Type Codes
- 1105 Standard Plan Waiting Period Codes
CHAPTER 12 – AUTOMATED MONTHLY
REPORTING
- 1201 Introduction
- 1202 Install Procedures
- 1203 Reporting to ETF
- 1204 A Few Tips Before Beginning
- 1205 Icons
- 1206 Main Screen
- 1207 Coverage Entry Screen for Active Employees
- 1208 Coverage Entry Adjustment Screen for Active Employees
- 1209 Entering Payment Information
- 1210 Export
- 1211 Print
- 1212 Report Formatting
- 1213 Roll Forward
- 1214 Back-Up
- 1215 Generation of Paper Copies of Reports
CHAPTER 13 – REFERENCE
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