1. How do I cancel health insurance coverage? How might this impact me if I later want to re-enroll?
If you are a retiree, you may cancel at anytime. You must provide written, signed notification of cancellation to ETF.
An employee’s 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 your premiums are being deducted on a pre-tax basis under Internal Revenue Code Section 125, 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 (not for example, Medicare); or
- You cancel your coverage during the annual 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 retirees) 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. (Retirees, please see the first paragraph in this Frequently Asked Question for important information.)
If your health insurance 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 an employee of a participating local employer) 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.
- Eligibility for coverage ceases (for example, termination of employment).
- 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 second reason requires Group Insurance Board approval.
- Your employer (for retirees, former employer) withdraws from the Wisconsin Public Employers Group Health Insurance Program.
Your coverage can be terminated because you:
- Became ineligible for coverage as a retiree because of becoming an active Wisconsin Retirement System employee. (See Changes in Employment Status FAQs 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 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 Medicare Information FAQs Question: When must I apply for Medicare? Active employees should contact their benefits/payroll/personnel office, retirees should contact ETF for the date coverage will end.
3. What if my employer's participation ends under the Wisconsin Public Employers Group Health Insurance Program?
When your employer's participation ends in this program, coverage will cease for all participants. This includes retirees, survivors and those who have continuation coverage. If the employer obtains group health insurance from another carrier, ask the employer if the new carrier will provide coverage for retirees, survivors and continuants.
When the employer terminates participation, you will not be eligible for continuation of health coverage.