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1. How are my health benefits affected by changes in employment status?
State only: State share toward premium will continue for the first three months after your leave begins. You can elect coverage for 36 months under Wis. Stat. 40.02(40)(followed by an additional 36 months of COBRA continuation). Arrangements for premium payment must be made with your benefits/payroll/personnel office prior to the time your leave of absence begins.
If you occupy a seasonal position and do not receive pay between the end of one term of service and the beginning of another, your coverage may continue if you authorize a payroll deduction before your earnings are interrupted or make other provisions to pay premiums in advance.
State only: State contributions toward premiums will be three months of state contribution in addition to any premium prepaid prior to the time of layoff. Arrangements for employee share of premium payment must be made with your benefits/payroll/personnel office prior to the date of layoff. You can elect coverage for up to 36 months under Wis. Stat. 40.02(40). If you have enough sick leave, that time period is extended.
Accumulated sick leave credits may be used to pay premiums for up to five years. A written request to use sick leave credit must be submitted to your benefits/payroll/personnel office before the date of layoff.
After 36 months or sick leave credits are exhausted, or if you have no sick leave credits available, COBRA continuation will be offered, which will allow you to purchase, at your own expense, an additional 36 months of coverage.
If you have 20 years of Wisconsin Retirement System service at the time of the layoff but were not eligible for an immediate annuity at the time of layoff, any sick leave remaining after paying premium during layoff is available upon retirement. You cannot use your sick leave after five years from the layoff date until you retire. If you had 20 years of WRS service and were eligible for an immediate annuity at the time of layoff, you may continue to use sick leave after five years or begin using it at anytime.
Unpaid Leave of Absence
State and Grad only: State share toward premiums will be three months of state contribution and any premium prepaid at the time your leave of absence begins. You can elect coverage for 36 months under Wis. Stat 40.02(40) (or beyond 36 months if the leave is military or union service). After these limits are reached, you may continue the coverage under COBRA for an additional 36 months. Arrangements for premium payment must be made with your benefits/payroll/personnel office prior to the time your leave of absence begins. If you do not continue coverage during your leave of absence, you will have no continuation rights if employment terminates.
Note: If your health coverage lapses in whole or only for your dependents during your leave due to nonpayment of premiums, you must submit a new application within 30 days of returning to work to reinstate, prospectively, the coverage that lapsed. Coverage will be effective the first of the month after the application is received by your payroll office. If a health benefits open enrollment period has occurred while you were on leave, you will be offered an enrollment opportunity upon your return to work.
A leave of absence is not considered ended until you have terminated employment or have returned to work for at least 50% of what is considered your normal work time for that employer for 30 consecutive calendar days.
State only: Lapsed coverage can also be reinstated for an employee who has been on a leave of absence and who is entitled to, and applies for, an immediate annuity. Coverage shall be effective the first day of the calendar month which occurs on or after the date the annuity application is approved by ETF, provided an application for health insurance has been received by that date.
Military Leave of Absence
State only: Under Wisconsin state law § 40.05 (4g), Wis. Stat., health insurance coverage may be continued under our program with employer contribution, as long as you are on active duty, your employee premium contribution continues to be paid and you elect coverage within 60 days of military activation. For more information on this option and the steps you need to take, contact your benefits/payroll/personnel office.
State only: If you transfer from one employing state department to another, you are required to file a new enrollment application within 30 days of the date you transfer to maintain continuous coverage. If an application is not filed within 30 days, coverage may be reinstated retroactively by submitting an application and paying back premiums. However, an employee in active pay status whose employee portion of premiums has not been deducted from salary by the employer for a period of 12 months, shall be deemed to have waived coverage. Waived coverage cannot be reinstated retroactively.
You may not select a new health plan when you submit your insurance application due to a transfer, unless it coincides with one of the other designated enrollment opportunities.
Grad only: If you transfer from one employing state department to another, contact your benefits/payroll/personnel office for information on how to maintain continuous coverage.
Termination of Employment
State and Grad only: Coverage will end at the end of the month in which the employee terminates employment.
Appealing a Discharge
State and Grad only: Coverage may be continued if you have been terminated from employment and are appealing discharge. The first premium payment and the appeal must both be filed within 30 days of discharge. Premium payments must be made through your employing agency and be received at least 30 days prior to the end of the period for which premiums were previously paid. You must pay the gross amount of premium due until the appeal is resolved. If the appeal is resolved in your favor, the amount normally considered state contribution will be refunded to you.
State only: If you are covered under the State of Wisconsin Group Health Insurance Program when you retire, the health benefit plan will automatically continue if your retirement annuity from the WRS begins within 30 days after employment ends. If you are eligible for Medicare, effective dates must be provided before coverage continues. If you are or become covered under a comparable non-state health plan at the time of retirement, you may escrow your sick leave credits to pay health premiums for use later. Contact ETF for further information.
You may be eligible for supplemental sick leave credits if you have at least 15 full years of adjusted continuous service with the state of Wisconsin at the time of retirement. (Continuous service means the number of full years the employee has worked for the state without a break in service. Local service does not apply.) Your employer will determine whether you are eligible for supplemental sick leave credits and submit the certification to ETF. If you have questions regarding your eligibility for supplemental sick leave credits, contact your payroll office.
If you are an employee who has not been covered by state group health insurance and want to save your sick leave credits for later use, you may enroll for coverage in the IYC Access Plan 30 days prior to retirement.
High Deductible Health Plans and Retirement
You may continue your HDHP in retirement as long as you are under age 65 and are not enrolled in any other coverage. You must also keep your Health Savings Account (HSA) with the state's sponsored program. You will not pay a monthly maintenance fee for the HSA if you maintain your HDHP coverage. You can contribute to your HSA post-tax as long as you continue to have the HDHP. Contributions can be made through your HSA portal account or by submitting a contribution form. You will not be able to contribute from your WRS annuity directly to your HSA.
If you are retired and Medicare eligible (either age 65 or older, or disabled), you must enroll in Medicare and move to the non-HDHP plan. You should contact ETF to arrange this change before your Medicare enrollment becomes active.
Medicare Part D
While The Centers for Medicare and Medicaid Services (CMS) considers Medicare Part D voluntary, Medicare-enrolled retirees will be automatically enrolled in the Navitus MedicareRx (PDP) plan, which is underwritten by Dean Health Insurance Inc., a federally-qualified Medicare contracting prescription drug plan. This is Medicare Part D coverage through an employer group waiver plan (EGWP) administered by Navitus Health Solutions, the state group health insurance program's pharmacy benefit manager. This replaces the commercial creditable coverage provided by Navitus prior to the retiree being enrolled in Medicare. Supplemental wrap coverage is also included to ensure your prescription drugs are covered when you reach the Medicare Part D coverage gap, commonly referred to as the "donut hole." Please see the Medicare Information section for additional information.
If you do not enroll for all available portions of Medicare (A, B and D) upon retirement, you may be liable for the portion of your claims that Medicare would have paid on the date Medicare coverage would have become effective. (See the Medicare Information provided later in this section.)
Premium rates for retired employees are the same as for the active employees (except that your premium will decrease when you or a dependent becomes covered by Medicare). The employer may, at its option, pay all or a portion of the premium. If any portion of the premium is employer paid, you must remit your portion of the premium directly to the former employer.
If/when your employer does not pay any portion of the premium, the premium will be deducted from your monthly annuity. If the annuity is not sufficient to allow a premium deduction, you will be billed directly.
2. How are my health benefits affected if I go to work for an employer not under the Wisconsin Retirement System?
If you go to work for an employer that does not participate in the WRS after retirement, your WRS annuity and health benefits will not be affected.
3. How are my health benefits and premiums affected if I return to work for an employer who is under the Wisconsin Retirement System?
If you return to work for a WRS-participating employer, you may be eligible to once again become an active WRS employee. If you do become an active WRS employee, your annuity will be suspended and you will no longer be eligible for health insurance as a retiree/annuitant. You will be eligible for health insurance as an active WRS employee through your WRS-participating employer if the employer is participating in the ETF health insurance program. If you work for a state employer, the state (non-graduate assistant) premium rates will apply. If your termination date from the WRS was prior to July 2, 2013, check with your employer to make sure you have other health insurance coverage available before you elect WRS participation.
As a state retiree, if you were paying for your health insurance from your converted sick leave credit account, your account will be inactivated if you return to work for a state government employer as a participating employee. Your sick leave credit account will be activated when you retire again. Any sick leave credit you accumulate during re-employment as a participating employee with a state government employer will be added to the balance in your account when you re-retire. If your re-employment is with a local government employer, and you have comparable health insurance coverage, you may escrow your sick leave account balance. Contact ETF or see the Sick Leave Credit Escrow Application (ET-4305) online. Your sick leave credit account balance will be available to you when you re-retire.
You may also waive or terminate enrollment under Medicare until the first Medicare enrollment period after active WRS employment ceases. While covered through active employment, your premium rates will be the active employee rates, not the Medicare rates.
When you subsequently terminate employment, eligibility for state group health coverage is once again dependent on your meeting the requirements for newly retired employees (that is, you must be insured, and you must apply for an immediate annuity from the WRS).
4. What if I'm a disability annuitant who returns to work?
If you are a disability annuitant under § 40.63(1) who is under normal retirement age and return to any employment, you are subject to a flat rate earnings limit. If you exceed your earnings limit, your disability annuity is suspended, but you will remain eligible for health insurance as an annuitant.
If you are receiving a disability annuity, you may not actively participate in the Wisconsin Retirement System until it is determined that you are no longer eligible for a disability annuity because of medical certification. If your disability annuity is terminated, and you are employed by a employer participating in the WRS, you will become eligible for the health insurance offered by your employer.
- If you return to state employment, you must file a new health application within 30 days after the date you resume active status under WRS.
- If you return to local public employment, you lose eligibility to remain in the State of Wisconsin Group Health Insurance Program. You may enroll in your public employer's health program (if one is offered), or you may elect continuation coverage of the State of Wisconsin Group Health Insurance Program for up to 36 months by applying within 60 days of being notified by ETF of your right to continue.
Important Caution: Continuation coverage will end after a maximum of 36 months. It does not make you eligible to re-enroll in the state health plan when you terminate. You will only be eligible for the health insurance your employer offers its retirees, subject to its rules and requirements.