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Selecting a Health Plan

1. Can family members covered under one policy choose different health plans?

*No, for all employees and any retirees and continuants who have single or family coverage where either all individuals have Medicare or none do.

*Yes, for retirees and eligible continuants who have family coverage where at least one individual has Medicare and at least one does not. This is called a Medicare Some contract. See Medicare Advantage FAQs Question: Can I or my Medicare enrolled dependent choose to be insured by IYC Medicare Advantage or Medicare Plus, and the non-Medicare individual choose a non-Medicare IYC Health Plan under my family coverage?

2. My employer offers the Uniform Dental Benefit. Can I elect a family plan for medical and an individual plan under the Uniform Dental Benefit?

No. Uniform Dental coverage mirrors your health insurance coverage. For example: If you elect family health insurance coverage with dental, you will be enrolled in family Uniform Dental coverage.

3. Can I receive medical care outside of my health plan network?

This can be a concern for members who travel and those with covered dependents living elsewhere, such as a college student living away from home. Consider the following when selecting a health plan:

If you are covered through an Local Health Plan HMO, you are required to obtain allowable care only from providers in the Local Health Plan HMO’s network. Local Health Plan HMOs will cover emergency care outside of their service areas, but you must get any follow-up care to the emergency from providers in the Local Health Plan HMO’s network. Do not expect to join a Local Health Plan HMO and get a referral to a non-HMO physician. A Local Health Plan HMO generally refers outside its network only if it is unable to provide needed care within the HMO.

If you are covered through a Preferred Provider Organization (PPO) such as the Access Plan, you have the flexibility to seek care outside a particular service area. However, out-of-network care is subject to higher deductible and coinsurance amounts.

Retirees only: If you or your dependents are covered through the IYC Medicare Advantage or Medicare Plus, you have the freedom of choice to see any provider who accepts Medicare. IYC Medicare Advantage-PPO offers coverage for participants with Medicare Parts A and B, with both in- and out-of-network benefits. For more information see www.medicare.gov/your-medicare-costs/part-a-costs/assignment/costs-and-assignment.html.

4. How can I get a listing of the physicians participating in each plan?

Contact the plan directly or follow the instructions found through the Health Plan Search page, by clicking on the health plan name. ETF and your benefits/payroll office do not have this information.

5. What steps should I follow to enroll in the health insurance program?

  • Determine which plans have providers in your area.
  • Contact the health plans directly for information regarding available physicians, medical facilities and services. If your employer offers Uniform Dental, you must contact Delta Dental directly for information regarding the Uniform Dental Benefit and dental providers.
  • Review the health plan rates, report card information and the Health Plan Search pages.
  • To enroll, contact your payroll or benefits personnel for instructions. Retirees should submit a Health Insurance Application/ Change for Retirees & COBRA Continuants (ET-2331) to ETF.

6. Someone on my health plan is in the middle of medical treatment and we have to change health plans. What do I need to do?

If you or someone in your family is in the middle of medical treatment or has complex healthcare needs when you need to change health plans, you should keep a few things in mind when you make your health plan choice. Check the provider directories of the health plans you are considering, and try to find one with your doctor in network.

Next, contact the plan you have selected and ask what their process is for transitioning your care. They may ask you to submit a form or to speak with someone in their care management team. 

New Employee Enrollment

7. When does my coverage go into effect as a new employee?

If eligible, you may enroll for individual or family coverage in any of the available health plans without restriction or waiting periods for preexisting medical conditions, provided you file an electronic or paper health application with your benefits/payroll office within the required enrollment period stated below:

  1. Within 30 days of your date of hire in an eligible position. Coverage will be effective the first day of the month on or following your hire date. You will have to pay the entire premium prior to becoming eligible for the employer share of the contribution. Check with your benefits person to see when your employer contribution begins. Or,
  2. Within 30 days prior to the date that the employer contributes to the premium, with coverage becoming effective when you become eligible for the employer contribution.
  3. You may also enroll during the annual open enrollment period for coverage to be effective January 1 of the following year.

There are no interim effective dates except as required by law. However, you may enroll for individual coverage within 30 days of your date of hire and change to family coverage if your application is received prior to the date the employer contributions begin.

If you cancel your policy prior to the date that the employer contribution starts, you may re-enroll in health insurance with the new coverage becoming effective on the first day of the month that employer contribution begins.

You cannot assume that the month when your first payroll deduction occurs is the month when your coverage begins. For further information on deductions, coverage and effective dates, contact your benefits/payroll office.

Important Information for Less Than Half-Time Employees:

The initial enrollment opportunity for most employees begins with their participation in the Wisconsin Retirement System. However, if you are a less than half-time employee, you have another enrollment period if:

  1. There has been a 30-day termination of employment break; or
  2. Your hours of employment increase due to a change in your appointment and you qualify for a higher share of employer contribution toward health insurance premiums; or
  3. You are appointed to a permanent position and now qualify for the full share of employer contribution.

If you apply for coverage within 30 days of one of these events, coverage will be effective on the later of the first of the month following the your new hire date, or the effective date of the increase in the employer contribution. Retroactive effective dates are not allowed. This does not provide an opportunity to change from individual to family coverage.

You may also enroll during the annual open enrollment period for coverage to be effective January 1 of the following year.

Other Enrollment Opportunities

8. Are there other enrollment opportunities available to me after my initial one expires?

You may be able to get health insurance coverage if you are otherwise eligible under specific circumstances as described below:

  • If you are an active employee and you and/or your dependent(s) are not insured under the Wisconsin Public Employers Group Health Insurance Program because of being insured under a group health insurance plan elsewhere, you may take advantage of a special 30-day enrollment period to become insured in this program if:
    • Your eligibility for that other coverage is lost involuntarily, or the employer's premium contribution for the other plan ends, or
    • You and/or your dependents lose medical coverage:
      • Under medical assistance (Medicaid); or
      • Upon return from active military service with the armed forces. Employees must return to employment within 180 days of release from active duty. You are entitled to enroll regardless of the coverage in effect. Coverage is effective on the date of your re-employment, or
      • As a citizen of a country with national health care coverage comparable to the Access Plan.

The enrollment period begins on the date the other group health insurance coverage terminates because of loss of eligibility (for example, termination of employment, divorce, etc., but not voluntary cancellation of coverage or the loss of COBRA) or the employer's premium contribution ends.

  • If you are currently enrolled in the Wisconsin Public Employers Group Health Insurance Program with individual coverage, because your dependents are insured under a group health insurance plan elsewhere, and eligibility for that coverage is lost or the employer's premium contribution for the other plan ends, you may take advantage of a special 30-day enrollment period to change from individual to family coverage. Coverage will be effective on the date the other coverage or the employer's premium contribution ends.
  • If you are currently enrolled in the Wisconsin Public Employers Group Health Insurance Program with family coverage, you may request to provide coverage for your eligible adult child who is not currently insured. For more information, see the FAQ section on Dependent Information and Eligibility. You do this during the annual open enrollment period. Coverage for your child will be effective the following January 1.
  • If you are not insured under the Wisconsin Public Employers Group Health Insurance Program and have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may enroll if coverage is elected within 30 days of marriage or 60 days of the other events. Coverage is effective on the date of marriage, birth, adoption or placement for adoption.
  • If you and/or your dependents lose medical coverage under the Children's Health Insurance Program (CHIP) or become eligible to participate in a premium assistance program, you will have an opportunity to enroll in the Wisconsin Public Employers Group Health Insurance Program without waiting periods for preexisting conditions by filing an application either electronically or via paper within 60 days of the loss of eligibility or the date you become eligible for premium assistance and by providing evidence satisfactory to ETF.
  • If you do not enroll during a designated enrollment period, you may enroll for health insurance coverage, if you are otherwise eligible, during the annual open enrollment period.

Retirees only

The following former employees are eligible to re-enroll during the annual open enrollment period, with coverage beginning the following January:

  • You were insured immediately prior to termination of employment with a local employer who did and continues to participate in the Wisconsin Public Employers Group Health Insurance Program; and
  • You are receiving a WRS retirement annuity or received a lump-sum WRS retirement benefit that began within 30 days of termination of employment. 
  • (Prospective retirees whose employer offers you any post-retirement employer premium contributions such as accumulated sick leave credits to pay for insurance) If you are an employee who is not enrolled under the Wisconsin Public Employers Group Health Insurance Program as you near retirement, and you wish to enroll in order to use your employer post-retirement premium contributions to pay for health insurance in retirement, you must enroll in the Access Plan effective the first of the month prior to retirement. You must have 30 days of employee coverage prior to retirement.
     

Open Enrollment

The annual open enrollment period is the opportunity for eligible employees and retirees to select or change to one of the many health plans offered by the Wisconsin Public Employers Group Health Insurance Program. The following list contains some of the most commonly asked questions about the enrollment period. You can also find information about key terms in the definitions section. Additional medical definitions are found in the online Certificates of Coverage.

9. What is an open enrollment period?

The annual open enrollment period is an opportunity to change plans, change from family to individual coverage, enroll if you had previously deferred coverage, cancel your coverage or cancel the coverage for your adult dependent child. It is offered only to employees, surviving spouses and dependents and eligible retirees and continuants who are eligible under the Wisconsin Public Employers Group Health Insurance Program. Changes made become effective January 1 of the following year.

Eligible retirees are those who are currently insured, or were insured when they retired with an employer who offers the Wisconsin Public Employers Group Health Insurance Program. See Question above: Are there other enrollment opportunities available to me after my initial one expires?

10. May I change from individual to family coverage during the open enrollment period?

Yes, coverage will be effective January 1 of the following year for all eligible dependents.

Making Changes During Open Enrollment

11. How do I change health plans during open enrollment?

If you decide to change to a different plan, you are encouraged to make changes online using the myETF Benefits website, or you may submit a paper application using the following instructions:

  • Active employees may download a paper application (ET-2301) or receive paper applications from your benefits/payroll/personnel office to complete and return to that office. 
  • Eligible Retirees and Continuants may get an application (ET-2331) online, or contact ETF for a copy and submit it to ETF. Applications received after the deadline will not be accepted.

Note: If you plan to stay with your current plan for next year and you are not changing your coverage, you do not need to take any action.

12. How do I use the myETF Benefits website?

Refer to the myETF Benefits System Instructions here.

13. What happens if I enter my changes online, but did not submit them?

Your changes will not be stored unless you click on the submit button. You will need to log back in and make the changes again. To view what you submitted, click the myRequests button on the bottom of the myInfo page.

14. What is the effective date of changes made during the open enrollment period?

Coverage changes are effective January 1 of the following year.

15. What if I change my mind about the health plan I selected during the open enrollment period?

You may submit or make changes anytime during the open enrollment period, either online using the myETF Benefits website or by filling out a paper application. After that time, you may rescind, that is, withdraw your application (and keep your current coverage) by following these instructions before December 31:

  • Active employees should inform their benefits/payroll office in writing; or
  • Insured retirees and continuants should notify ETF in writing.

Other rules apply when canceling coverage. For more information, see the Cancellation or Termination of Coverage Frequently Asked Question section.

16. Which other changes can be made during the open enrollment period if my health insurance premiums are taken pre-tax?

During the annual open enrollment period, you can add or drop coverage for yourself and/or your adult dependent children or do a spouse to spouse transfer of your health insurance coverage.

Retiree Enrollment

Important Note: If you are eligible or will become eligible for Medicare, also see the Medicare Information Frequently Asked Question section.

17. What happens to my health insurance when I become a retiree?

When you retire, your health insurance plan will automatically continue if your retirement annuity from the Wisconsin Retirement System begins within 30 days after your employment termination date. If you do not wish to continue coverage, you must notify ETF in writing.