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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2018 Local Deductible Health Plan Insurance Program
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2018 It's Your Choice - Local Deductible Health Plan Insurance for Employees and Retirees
Wisconsin Department Of Employee Trust Funds It's Your Choice 2018


Local Deductible Plan
Insurance for Employees
and Retirees
(PO4, PO14)


Life Event Change Guide

Did you recently have a change in marital status, have a baby, an eligible move to a new county or another life change event? You may have the opportunity to enroll (employees only) or change your coverage (employees and retirees) outside of the open enrollment period. There are various rules related to life change events.

*You may be able to change coverage outside of the IYC period if the following apply. (If you are a retiree, a state employee who has opted out of premium conversion under Section 125, or are a local employee who does not have their health insurance premium contribution deducted pre-tax under a federal Section 125 plan--you may change from family to single coverage at any time.)

For more detail see Frequently Asked Questions online. Employees may also contact your payroll/benefit office.  Annuitants and continuants may contact ETF.

Once you've reviewed if you are eligible to make a change, submit a paper application, or for some employees, submit online with your employer.


  Enrollment opportunity? Change  coverage (single-family or family-single)? Change Health Plan? Drop a dependent and keep family coverage? Cancel coverage? Deadline to submit application  Effective Date
HEALTH and UNIFORM DENTAL INSURANCE Yes Yes Yes No Yes Within 30 days of event Coverage becomes effective on the date of the marriage
SUPPLEMENTAL BENEFITS No; members may only add dependents to plans on which they are already enrolled Yes n/a No Yes Within 30 days of event Coverage becomes effective on the 1st of the month following the date of the marriage
LIFE INSURANCE
Yes Yes - may enroll in Basic coverage, or increase their employee coverage by one level, and enroll in one (1) or two (2) units of Spouse and Dependent coverage without evidence of insurability n/a n/a May cancel all coverage, or certain levels of coverage at anytime. Within 30 days of event Coverage becomes effective (for claims purposes) on the date that the completed application is received.

 

  Enrollment opportunity? Change  coverage (single-family or family-single)? Change Health Plan? Drop a dependent and keep family coverage? Cancel coverage? Deadline to submit application  Effective Date
HEALTH and UNIFORM DENTAL INSURANCE Yes if losing other medical coverage as a dependent. Yes Yes Yes Yes File an application or change information online within 30 days of the event. Coverage becomes effective on the end of the month following the divorce (or the date that the Continuation-Conversion Notice (ET-2311) is provided to the divorced spouse).
SUPPLEMENTAL BENEFITS Yes if losing comparable coverage. Yes n/a Yes Yes File an application or change information online within 30 days of the event. Coverage becomes effective on the end of the month following the divorce (or the date that the Continuation Notice for each plan is provided to the divorced spouse). 
LIFE INSURANCE
No n/a n/a n/a Coverage may be cancelled at any time. n/a n/a

 

  Enrollment opportunity? Change  coverage (single-family or family-single)? Change Health Plan? Drop a dependent and keep family coverage? Cancel coverage? Deadline to submit application  Effective Date
HEALTH and UNIFORM DENTAL INSURANCE Yes. Also includes birth of grandchild from your covered dependent under age of 18.  (Your grandchild becomes ineligible at the end of the month in which the parent, your dependent, turns age 18.) Yes Yes No Yes File an application or enroll online within 60 days of the event.  Coverage becomes effective on the date of the event.
SUPPLEMENTAL BENEFITS No; members may only add dependents to plans on which they are already enrolled. Yes n/a No Yes File an application or enroll online within 60 days of the event.  Coverage becomes effective on the date of the event.
LIFE INSURANCE
Yes Yes - may enroll in Basic coverage, or increase employee coverage by one level, and enroll in one (1) or two (2) units of Spouse and Dependent coverage without evidence of insurability. n/a n/a May cancel all or certain levels of coverage at anytime. Within 30 days of event. Coverage becomes effective (for claims purposes) on the date that the completed application is received.

 

  Enrollment opportunity? Change  coverage (single-family or family-single)? Change Health Plan? Drop a dependent and keep family coverage? Cancel coverage? Deadline to submit application  Effective Date
HEALTH and UNIFORM DENTAL INSURANCE Yes Yes, single to family.   Yes No Yes File an application or enroll online within 60 days of the event.  Coverage becomes effective on either 1: the first of the month following receipt of the application by the employer or ETF for annuitants/continuant or 2: the date specified in the Medical Support Notice.  
SUPPLEMENTAL BENEFITS No; members may only add dependents to plans on which they are already enrolled. Yes, single to family.   n/a No Yes File an application or enroll online within 60 days of the event.  Coverage becomes effective on either 1: the first of the month following receipt of the application by the employer or ETF for annuitants/continuant or 2: the date specified in the Medical Support Notice.  
LIFE INSURANCE
No n/a n/a n/a May cancel all or certain levels of coverage at anytime. n/a n/a

 

  Enrollment opportunity? Change  coverage (single-family or family-single)? Change Health Plan? Drop a dependent and keep family coverage? Cancel coverage? Deadline to submit application  Effective Date
HEALTH and UNIFORM DENTAL INSURANCE Yes Yes, single to family.   Yes No Yes File an application or enroll online within 60 days of the event. Children born outside of marriage become dependents of the father on the date of the court order declaring paternity, on the date the acknowledgement of paternity is filed with the Department of Health Services (or equivalent if the birth was outside of the state of Wisconsin) or on the date of birth with a birth certificate listing the father's name. The effective date of coverage will be the birth date, if a statement of paternity is filed within 60 days of the birth. If filed more than 60 days after the birth, coverage will be effective on the first of the month following receipt of application.
SUPPLEMENTAL BENEFITS No; members may only add dependents to plans on which they are already enrolled. Yes, single to family.   n/a No Yes File an application or enroll online within 60 days of the event. Coverage becomes effective on the date of the event.
LIFE INSURANCE
Yes Yes - may enroll in Basic coverage, or increase employee coverage by one level, and enroll in one (1) or two (2) units of Spouse and Dependent coverage without evidence of insurability. n/a n/a May cancel all or certain levels of coverage at anytime. Within 30 days of event. Coverage becomes effective (for claims purposes) on the date that the completed application is received.

 

  Enrollment opportunity? Change  coverage (single-family or family-single)? Change Health Plan? Drop a dependent and keep family coverage? Cancel coverage? Deadline to submit application  Effective Date
HEALTH and UNIFORM DENTAL INSURANCE Yes Yes, single to family.   No No Yes File an application or enroll online within 60 days of the event.  The effective date of coverage will be the date of the event.
SUPPLEMENTAL BENEFITS No; members may only add dependents to plans on which they are already enrolled. Yes, single to family.   n/a No Yes File an application or enroll online within 60 days of the event.   The effective date of coverage will be the birth date, if a statement of paternity is filed within 60 days of the birth. If filed more than 60 days after the birth, coverage will be effective on the first of the month following receipt of application.
LIFE INSURANCE
No n/a n/a n/a May cancel all or certain levels of coverage at anytime. n/a n/a

 

  Enrollment opportunity? Change  coverage (single-family or family-single)? Change Health Plan? Drop a dependent and keep family coverage? Cancel coverage? Deadline to submit application  Effective Date
HEALTH and UNIFORM DENTAL INSURANCE Yes Yes - Single to Family No No Yes File an application or enroll online within 30 days of the event.  Coverage becomes effective on the date of the event.
SUPPLEMENTAL BENEFITS No; members may only add dependents to plans on which they are already enrolled. Yes, single to family.   n/a No Yes File an application or enroll online within 30 days of the event.  Coverage becomes effective on the 1st of the month following the date of the event.
LIFE INSURANCE
No n/a n/a n/a May cancel all or certain levels of coverage at anytime. n/a n/a

 

  Enrollment opportunity? Change  coverage (single-family or family-single)? Change Health Plan? Drop a dependent and keep family coverage? Cancel coverage? Deadline to submit application  Effective Date
HEALTH and UNIFORM DENTAL INSURANCE No Yes, family to single.  No Yes Yes File an application within 30 days of enrollment in other coverage.  Coverage becomes effective on the first of the month following the receipt of application. This coverage ends the end of the month following receipt of application.
SUPPLEMENTAL BENEFITSNo Yes, family to single.  n/a Yes Yes; new coverage must be comparable to the Supplemental Plan in which the employee or annuitant is enrolled. File an application within 30 days of enrollment in other coverage.  Coverage becomes effective on the first of the month following the receipt of application. This coverage ends the end of the month following receipt of application.
LIFE INSURANCE
n/a n/a n/a n/a n/a n/a n/a

 

  Enrollment opportunity? Change  coverage (single-family or family-single)? Change Health Plan? Drop a dependent and keep family coverage? Cancel coverage? Deadline to submit application  Effective Date
HEALTH and UNIFORM DENTAL INSURANCE Yes Yes Yes No No File an application or enroll online within 30 days of the event. Coverage becomes effective on the date the other coverage terminates except for a change of health plan. Health plan changes are effective the first of the month following receipt of application.
SUPPLEMENTAL BENEFITSYes Yes n/a No No File an application or enroll online within 30 days of the event. Coverage becomes effective on the date the other coverage terminates.
LIFE INSURANCE
n/a n/a n/a n/a n/a n/a n/a

 

  Enrollment opportunity? Change  coverage (single-family or family-single)? Change Health Plan? Drop a dependent and keep family coverage? Cancel coverage? Deadline to submit application  Effective Date
HEALTH and UNIFORM DENTAL INSURANCE Yes Yes, single to family.  Yes Yes Yes File an application within 30 days of increase in employer contribution.  Coverage becomes effective on the first of the month following the receipt of application. This coverage ends the end of the month following receipt of application.
SUPPLEMENTAL BENEFITSNo, unless the employer contribution increase results in new eligibility for State Group Health Insurance. No n/a No No File an application within 30 days of increase in employer contribution. Coverage becomes effective on the first of the month following the receipt of application. This coverage ends the end of the month following receipt of application.
LIFE INSURANCE
n/a n/a n/a n/a n/a n/a n/a

 

  Enrollment opportunity? Change  coverage (single-family or family-single)? Change Health Plan? Drop a dependent and keep family coverage? Cancel coverage? Deadline to submit application  Effective Date
HEALTH and UNIFORM DENTAL INSURANCE No No Yes No No File an application or enroll online within 30 days after the move. Coverage becomes effective on the first of the month following the  receipt of application.
SUPPLEMENTAL BENEFITSNo No n/a No No n/a n/a
LIFE INSURANCE
n/a n/a n/a n/a n/a n/a n/a

 

  Enrollment opportunity? Change  coverage (single-family or family-single)? Change Health Plan? Drop a dependent and keep family coverage? Cancel coverage? Deadline to submit application  Effective Date
HEALTH and UNIFORM DENTAL INSURANCE No Yes, family to single.  No No Yes Coverage automatically continues unless an application is filed. A change in coverage becomes effective on the first of the month following the  receipt of application.  Coverage ends the month for which premiums have not been paid.
SUPPLEMENTAL BENEFITS
Note: See plan manual for restrictions on re-enrollment and lapse in coverage
No No n/a No Yes Coverage automatically continues unless an application is filed. A change in coverage becomes effective on the first of the month following the  receipt of application.  Coverage ends the month for which premiums have not been paid.
LIFE INSURANCE
Yes n/a n/a n/a May cancel all or certain levels of coverage at anytime. Within 30 days of return to work. Employees also have the option to keep the coverage during leave of absence and continue to pay the premiums on their own. Coverage becomes effective (for claims purposes) on the date that the completed application is received.

 

  Enrollment opportunity? Change  coverage (single-family or family-single)? Change Health Plan? Drop a dependent and keep family coverage? Cancel coverage? Deadline to submit application  Effective Date
HEALTH and UNIFORM DENTAL INSURANCE No, unless uninsured employee chooses to enroll in the IYC Access Plan 30 days prior to retirement.
STATE: (for 1 month of coverage) in order to escrow sick leave upon retirement.
LOCAL: in order to use post- retirement employer premium contributions.
Yes, when you become a retiree, or if you are a state employee who has opted out of premium conversion under Section 125, or are a local employee who does not have their health insurance premium contribution deducted pre-tax under a federal Section 125 plan. If so, you may change from family to single coverage at any time. No No Yes Coverage automatically continues unless an application is filed within 30 days of the event. Coverage begins the first of the month following receipt of the application.  Coverage must be in effect 30 days prior to retirement.  Coverage ends the month in which the employment terminates.
SUPPLEMENTAL BENEFITSNo, except when an employee is already enrolled in a Supplemental Plan and chooses to continue coverage as a Retiree/Annuitant in the same plan. A Continuation Application must be filed indicating Retirement as the Continuation Reason. Yes n/a No Yes Coverage terminates unless a continuation application is filed within 30 days of event. Coverage begins the first of the month following receipt of the application.  Coverage must be in effect 30 days prior to retirement.  Coverage ends the month in which the employment terminates.
LIFE INSURANCE
n/a n/a n/a n/a n/a n/a n/a

 

  Enrollment opportunity? Change  coverage (single-family or family-single)? Change Health Plan? Drop a dependent and keep family coverage? Cancel coverage? Deadline to submit application  Effective Date
HEALTH and UNIFORM DENTAL INSURANCE No, unless the employee is losing other group coverage as a dependent. Yes , family to single if you have no other deps No Yes Yes If you are an employee, please submit an application to your employer removing your spouse.  For retirees, you only need to file an application if you wish to terminate coverage. Coverage ends on the first of the month following receipt of application.
SUPPLEMENTAL BENEFITSNo, unless the employee is losing other comparable coverage as a dependent. Yes , family to single if you have no other deps n/a Yes Yes If you are an employee, please submit an application to your employer removing your spouse.  For retirees, you only need to file an application if you wish to terminate coverage. Coverage ends on the first of the month following receipt of application.
LIFE INSURANCE
No  n/a n/a n/a May cancel all or certain levels of coverage at anytime. n/a n/a

 

  Enrollment opportunity? Change  coverage (single-family or family-single)? Change Health Plan? Drop a dependent and keep family coverage? Cancel coverage? Deadline to submit application  Effective Date
HEALTH and UNIFORM DENTAL INSURANCE Yes, for the child to be added to your existing coverage.  Yes, single to family coverage. No No No File an application or enroll online within 30 days of the event.  The health plan determines if the child meets the disabled dependent criteria. Coverage becomes effective on the first of the month following determination that the adult child meets the disabled dependent criteria.
SUPPLEMENTAL BENEFITSYes, for the child to be added to your existing coverage.  Yes, single to family coverage. n/a No No File an application or enroll online within 30 days of the event.  The insurer determines if the child meets the disabled dependent criteria. Coverage becomes effective on the first of the month following determination that the adult child meets the disabled dependent criteria.
LIFE INSURANCE
No  n/a n/a n/a May cancel all or certain levels of coverage at anytime. n/a n/a

 

Disclaimer:
Every effort has been made to ensure that this information is accurate, but may be subject to change. Please note revision dates located at the bottom of each page. In the event of conflicting information, federal law, state statute, state health contracts and/or policies and provisions established by the State of Wisconsin Group Insurance Board shall be followed.

This page was last modified on: 1/24/2018 3:05:51 PM