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Wisconsin Retirement System
Income Continuation Insurance Administration Manual
(State)
ET-1119, Rev. 7/2005
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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-2405)
- 108 Confidentiality of Records
- 109 Ordering Income Continuation Insurance Forms
- 110 Income Continuation Insurance Forms/Booklets Order Form
- 111 Internet Address - http://etf.wi.gov
CHAPTER 2 -- ELIGIBILITY CRITERIA
- 200 Newly Hired Employee Eligibility Criteria
- 201 Determining Initial Insurance Eligibility Date
- 202 Eligibility Dates for New Hires without Previous Service
- 203 WRS Previous Service Check
- 204 WRS Previous Service Checks Form (ET-1715)
- 205 Rehired/Returning Employee Eligibility
- 206 Interrupted Service/Leaves of Absence
- 207 Change to LTE, Project or Other Employment Status
- 208 Change to or from UW Faculty/Academic Staff Positions
- 209 Reinstatement Due to Settlement Agreement
CHAPTER 3 -- ENROLLMENT AND APPLICATION
- 300 Applying for Income Continuation Insurance - New Employee
- 301 Three Enrollment Opportunities
- 302 Employee Completion of Income Continuation Insurance
Application (ET-2307)
- 303 Employer Completion of Income Continuation Insurance
Application (ET-2307)
- 304 Sample - Income Continuation Insurance Application
(ET-2307)
- 305 Distribution of Copies
- 306 Application Due Date and Effective Date of Coverage (Chart)
- 307 Instructions for Completing the Evidence of Insurability
Application (ET-2308)
- 308 Sample - Evidence of Insurability Application (ET-2308)
- 309 Sample - Notice of Approval of Coverage Under Evidence of
Insurability
- 310 Sample - Notice of Denial of Coverage Under Evidence of
Insurability
- 311 Sample - Notice of Approval of Coverage After Reconsideration
- 312 Sample - Notice of Denial of Coverage After Reconsideration
CHAPTER 4 -- EMPLOYEE AND EMPLOYER
PREMIUMS
- 400 Basis for Premium Contribution Rates
- 401 Employee Monthly Premium Rates - State Employees
- 402 Employee Monthly Premium Rates - UW Faculty
- 403 Calculating Employer Premium Share
- 404 Annual Premium Update
CHAPTER 5 -- MONTHLY PREMIUM REPORT
- 500 Completing the Monthly Premium Report Group Income
Continuation Insurance (ET-1611) for State Employee Plan
- 501 Sample - Monthly Premium Report Group Income Continuation
Insurance (ET-1611)
- 502 Completing the Monthly Premium Report Group Income
Continuation Insurance (ET-1612) for UW Faculty Plan
- 503 Sample - Monthly Premium Report Group Income Continuation
Insurance (ET-1612)
- 504 Premium Remittance
- 505 Due Date
- 506 Late Reporting Interest Charge
- 507 Permanent Change in Percentage of Appointment
CHAPTER 6 -- TERMINATION OF COVERAGE
- 600 Termination of Coverage
- 601 Lapse in Coverage
- 602 Cancellation of Coverage
CHAPTER 7 -- BENEFITS
- 700 Introduction
- 701 Eligibility for Income Continuation Insurance 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 Income Continuation Insurance
Benefits
- 712 Taxability of Income Continuation Insurance Benefit
CHAPTER 8 -- CLAIM PROCESS
- 800 Filing an Income Continuation Insurance 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 Income Continuation Insurance Claim Form (ET-5352)
- 806 Income Continuation Insurance Employer Statement
(ET-5351)
- 807 Sample - Income Continuation Insurance Claim Approval Notice
- 808 Sample - Income Continuation Insurance Claim Denial Notice
- 809 Sample - Income Continuation Insurance 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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