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Employers

$2,000 Health Insurance Opt-Out Incentive FAQs
Revised September 15, 2015

This opt-out incentive is available only to eligible State of Wisconsin employees; however, local employers may choose to offer a similar program in 2016.

  1. Will the opt-out incentive payments be paid in a lump sum?

    No, incentive payments will be spread out over all applicable pay periods in the year. Further details on how to handle any proration of the $2,000 will be forthcoming.

  2. Do all WRS eligible employees who are not enrolled in state group health insurance qualify, or do employees only qualify if they formally submit a form indicating they are opting out of health insurance?

    Employees must submit a health insurance application indicating they are opting out. The new application will include an opt-out check box and will include an eligibility attestation statement.

  3. Will someone who opted out of state group health insurance coverage in 2015 ever be eligible for the opt-out incentive?

    No, not as the law is currently written. This is one of the listed exclusions in Wisconsin Act 55 – s. 40.513 (3) (a), Wis. Stats.

  4. Who will track the 2015 opt outs?  

    ETF will create a master list, which will be available to employers to use in determining eligibility.

  5. Who will verify eligibility (including 2015 ineligible employees and not a covered dependent on another contract)? 

    Before paying any opt-out incentives, the employer will compare the employee to ETF's 2015 opt-out master list, which is compiled from myETF Benefits enrollment system data. In addition, all employees will be required to attest to their eligibility for this incentive on the health insurance application form.

  6. How is the opt-out incentive treated for mid-year new hires?

    If an employee makes the election to opt out within 30 days of being hired, the employer shall prorate the $2,000 stipend according to the remaining number of pay periods in the calendar year in which the election is made.

  7. What if an employee leaves state service and returns in a future year? 

    Employee is eligible for the incentive unless they opted out in 2015.

  8. If an employee opts in before the end of the year (2015), will they be eligible for the incentive in future years? 

    Yes.

  9. Will a state employee be eligible for the incentive if they are covered under the Wisconsin Public Employers (WPE; a.k.a., local) Group Insurance Program?

    Yes.

  10. Are employees ineligible for the incentive if they are covered for one day in the calendar year? 

    Yes.

  11. Is the opt-out incentive considered taxable income? 

    Yes and it will appear on employees' W-2 statements.  In addition, the incentive payment is not considered WRS earnings.

  12. What will happen if an employee has received opt-out incentive payment(s) and then experiences a mid-year involuntary loss of non-state coverage, which creates a special 30-day enrollment opportunity? Note: statute says they would not be eligible for coverage, but federal HIPAA rules apply. 

    Incentive payments will stop as soon as the employee enrolls for coverage.

  13. Can employees opt in one year, then opt out the next, receive the incentive, then opt in the following year and continue this pattern to be eligible for the incentive every other year? 

    Yes

  14. Are LTEs eligible (if eligible for group health participation)? 

    Yes, and they are eligible for the full $2,000, as long as they meet the other eligibility requirements.

  15. Are less-than half-time employees eligible?

    Yes, and they are eligible for the full $2,000, as long as they meet the other eligibility requirements.

  16. Are employees on a leave of absence eligible?

    Yes, as long as they are eligible for health insurance and they meet the other eligibility requirements.

  17. Are Craftworkers eligible? 

    No, because they are not eligible for the employer contribution.

 

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