Revised October 22, 2015
Health Insurance - Coverage
- If hired prior to the first of the month and the health insurance application is completed by the first of the month, but the first day of work is actually after the first, for example the third of the month, can health insurance begin on the first of that month?
No, coverage would begin the first of the following month. The WRS coverage effective date would be the employee's first day on the job for compensation, not the date the job was offered and accepted. You cannot have health insurance coverage prior to being WRS eligible, therefore, health insurance coverage would be effective the first of the month following the WRS coverage effective date.
- How and when can a health program option change be made, for example, if a Wisconsin Public Employer (WPE) wants to switch from the IYC Local Traditional plan to the IYC Local Deductible plan or the IYC Local Traditional plan without Dental?
The governing body of the employer would need to file a resolution, which must be received by ETF no later than October 1, for a January 1 effective date.
- What is the effective date of family coverage when marriage occurs resulting in a switch from single to family health insurance coverage? When do family premiums begin?
Family coverage is effective the date of the marriage. When the marriage occurs before the 16th of the month, family premiums are due for the month of the marriage. When the marriage occurs after the 15th of the month, family premiums are due for the following month.
- Employee with single health insurance coverage is getting married on the 13th of the month and wants family coverage. The spouse has health coverage with another employer not under the state or WPE. Due to the marriage occurring prior to the 16th of the month, family premiums will be due for the month of the marriage. Can the family coverage begin the 1st of the next month to avoid double coverage and payment?
No, if family coverage is elected it must begin on the qualifying event, i.e., the date of marriage. Another option to consider would be to keep the two single coverages until a child enters the picture. Otherwise, the family premium is required for the month of the marriage when the marriage occurs prior to the 16th of the month. Single coverage payment would still be due on the other plan.
- When an employee terminates, transfers, or is deceased and premiums for the next month have already been paid, do they have coverage for that next month or should the employer request a premium refund?
An employee has health insurance coverage through the end of the month of their termination, transfer, or death. Any premiums paid for following months should be refunded.
- A newly hired employee is eligible for WRS and health insurance coverage on their first day of work. The employee then terminates before being employed for 30 calendar days. What happens with their health insurance coverage? What if there were claims during that period?
Employment of less than 30 calendar days makes that period ineligible for WRS coverage and their WRS account should be terminated accordingly (refer to WRS Administration Manual (ET-1127)). However, per Wis. Stat. 40.22 (6), an employee's employment that terminates after a period of service less than 30 calendar days can not affect their eligibility for health insurance coverage. Therefore, health insurance coverage is valid for that time period.
- When two members of a family have coverage under different health plans, how do the plans coordinate the benefit payment to the provider? Which is the primary plan? Do they use the birth date rule?
Beginning in 2016, dependents may only be covered once under both the State of Wisconsin Group Health Insurance Program and the Wisconsin Public Employers Group Health Insurance Program. In the event it is determined that a dependent is covered by two separate subscribers, the subscribers will be notified and will have 30 days to determine which subscriber will remove coverage of the dependent and submit an application to remove the dependent. The effective date will be the first of the month following receipt of the application. The health plan(s) will be notified.