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Wisconsin Retirement System
Income Continuation Insurance Administration Manual
(Local Government Employers)
ET-1145, Rev. 12/2004
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TABLE OF CONTENTS
PREFACE
CHAPTER 1 -- GENERAL INFORMATION
- 100 Introduction
- 101 Program Features
- 102 Administration
- 103 Division of Responsibilities
- 104 Administrative Offices and Contacts
- 105 Complaint Resolution
- 106 ETF Ombudsperson Services
- 107 Insurance Complaint form (ET-2406)
- 108 Confidentiality of Records
- 109 Ordering ICI Forms
- 110 ICI Forms/Booklets Order Form
- 111 Internet Address
CHAPTER 2 -- ELIGIBILITY CRITERIA
- 200 Who is ICI Eligible?
- 201 Determining ICI Coverage Effective Date
- 202 Eligibility Dates for New Hires without Previous Service
- 203 Rehired/Returning Employee Eligibility
- 204 Interrupted Service/Leaves of Absence
- 205 Settlement Agreements and Reinstatement
- 206 WRS Previous Service Check
- 207 WRS Previous Service Check Form (ET-1715)
CHAPTER 3 -- ENROLLMENT AND APPLICATION
- 300 Applying for Income Continuation Insurance - New Employee
- 301 Employee Completion of ICI Application
- 302 Employer Completion of ICI Application
- 303 Sample - Income Continuation Insurance Application
(ET-2307)
- 304 Distribution of Copies
- 305 Application Due Date and Effective Date of Coverage
- 306 Instructions for Completing the Evidence of Insurability
Application (ET-2308)
- 307 Evidence of Insurability Application (ET-2308)
- 308 Sample
- Notice of Approval of Coverage Under Evidence of Insurability
- Notice of Denial of Coverage Under Evidence of Insurability
- Notice of Approval of Coverage After Reconsideration
- Notice of Denial of Coverage After Reconsideration
CHAPTER 4 -- EMPLOYEE AND EMPLOYER
PREMIUMS
- 400 Basis for Premium Rates
- 401 Employee Monthly Premium Rates
- 402 Calculating Employer and Employee Premium
- 403 Annual Premium Update
CHAPTER 5 -- MONTHLY PREMIUM REPORT
- 500 Completing the Monthly Premium Report Group Income
Continuation Insurance (ET-1629)
- 501 Due Date
- 502 Late Reporting Interest Charge
- 503 Permanent Change in Percentage of Appointment
- 504 Monthly Premium Report Group Income Continuation Insurance
(ET-1629)
CHAPTER 6 -- TERMINATION OF COVERAGE
- 600 Termination of Coverage
- 601 Lapse in Coverage
- 602 Cancellation of Coverage
- 603 Employer Withdrawal from the ICI Program
- 604 Resolution to Withdraw from the Wisconsin Public Employers'
Group Income Continuation Insurance Program (ET-1322)
CHAPTER 7 -- BENEFITS
- 700 Introduction
- 701 Eligibility for ICI Benefits
- 702 Determining Dates of the Elimination Period
- 703 Earnings for Benefit Payment Purposes
- 704 Benefit Payments
- 705 Dates of Benefit Payment Checks
- 706 Continuation of Benefit
- 707 Maximum Duration of Benefits
- 708 Offsets From Other Benefit Sources
- 709 Reduction or Termination of Benefits
- 710 Rehabilitative Training
- 711 Social Security Withholding on ICI Benefits
- 712 Taxability of ICI Benefit
CHAPTER 8 -- CLAIM PROCESS
- 800 Filing an ICI Claim
- 801 Employer Information Required by the Third Party Administrator
- 802 Third Party Administrator Claim Review
- 803 Approval, Denial or Termination Notice
- 804 Waiver of Premium
- 805 ICI Claim Form (ET-5352)
- 806 ICI Employer Statement (ET-5351)
- 807 Sample - ICI Claim Approval Notice
- 808 Sample - ICI Claim Denial Notice
- 809 Sample - ICI Claim Denial/Closure Notice
CHAPTER 9 -- CLAIMANT CHANGE IN WORK
STATUS
- 900 Change in Work Status
- 901 Completing the Income Continuation Insurance Report
of Employment and Earnings (ET-5901)
- 902 Income Continuation Insurance Report of Employment and
Earnings (ET-5901)
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