1. How do I cancel coverage?
Voluntary cancellation (or switching from family to individual coverage which is deemed voluntary cancellation for all insured dependents) requires written, signed notification to the employer denoting a cancellation of coverage. If you are a retiree, you may cancel at any time. You must provide written, signed notification of cancellation to ETF.
If your premiums are being deducted on a pre-tax basis, you may cancel coverage only if:
- you experience a qualifying change or life event and submit an application to cancel coverage within 30 days of the event;
- you terminate employment;
- you become eligible for and enroll in another group health insurance plan; or
- you cancel your coverage during the annual It's Your Choice open enrollment period.
If your adult dependent child becomes eligible for and enrolled in other group health insurance coverage, and you want to drop coverage for him/her, you must submit an application electronically or via paper to your employer (to ETF for annuitants) within 30 days of the effective date of other coverage. In addition, you must submit proof of enrollment such as an ID card from that coverage. If this is your last dependent and you want to change to individual coverage, you must note that on your application.
If your spouse becomes eligible for and enrolled in other group health insurance coverage, and you want to change to individual coverage or cancel your family coverage, you must submit an application electronically or via paper to your employer (to ETF for retirees) within 30 days of the effective date of other coverage. In addition, you must submit proof of enrollment such as an ID card that lists all individuals covered under that plan.
If your premiums are being deducted post-tax, you may cancel at anytime.
Be aware that voluntary cancellation of coverage does not provide an opportunity to continue coverage for previously covered dependents as described in the Continuation of Health Coverage section. Cancellation affects both medical and prescription drug coverage.
No refunds are made for premiums paid in advance unless your employer (or ETF, if you are no longer a state employee) receives your written, signed request on or before the last day of the month preceding the month for which you request the refund. Under no circumstances are partial month's premiums refunded. Once coverage terminates, you will be responsible for any claims inadvertently paid beyond your coverage effective dates.
2. When can my health insurance coverage be terminated?
Your coverage can only be terminated because:
- Premiums are not paid by the due date. Coverage is also waived (known as "constructive waiver") when the employee portion of the premium is not deducted for 12 consecutive months.
- Coverage is voluntarily canceled.
- Death of the subscriber.
- Fraud is committed in obtaining benefits or there is an inability to establish a physician/patient relationship. Termination of coverage for this reason requires Group Insurance Board approval.
State and Grad only: Your coverage can be terminated because your eligibility for coverage ceases (for example, termination of employment).
Retirees only: Your coverage can be terminated because you:
- Became ineligible for coverage as an annuitant because of becoming an active Wisconsin Retirement System employee. (See Question: How are my health benefits affected by my return to work for an employer who is under the WRS?)
- IYC Medicare Advantage enrollees only: Dropped Medicare Part B. Your coverage will change to IYC Medicare Plus. You may also change health plans.
The Medicare enrollment requirement is deferred while you or your spouse are employed and covered under a group health insurance plan from that employment. (See Question: When must I apply for Medicare?) Active employees should contact their benefits/payroll/personnel office (retirees and continuants should contact ETF) for the date coverage will end.
3. Is it possible to enroll or re-enroll in this health insurance program after I terminate state employment?
State and Retirees only: If you terminate state employment and you are not enrolled for health insurance or subsequently terminate coverage, you may enroll for individual or family coverage if you are:
- A retired employee of the state who is receiving a retirement annuity or has received a lump-sum payment under Wis. Stat. § 40.25 (1); or
- An employee of the state who terminates service after attaining 20 years of creditable service, remains a Wisconsin Retirement System participant and is not eligible for an immediate annuity.
If you are eligible, you must submit an electronic or paper application to enroll during the open enrollment period and may select any offered health plan. Surviving dependents are not eligible for this enrollment.
4. Is there any state contribution for health insurance after I terminate coverage?
State only: Yes. Under certain circumstances, your accumulated unused sick leave can be converted to credits to pay for health insurance premium if you are:
- Terminating after accumulating 20 years of creditable Wisconsin Retirement System service, or
- Surviving dependents who are insured under our program at the time of the active subscriber's death.
The rules governing eligibility are described in ETF publications Sick Leave Credit Conversion Program (ET-4132), Group Health Insurance (ET-4112), Information for Retirees (ET-4116) and Your Benefit Handbook (ET-2119).