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Employees

1. How are my health benefits affected by changes in employment status?

Layoff/Leave of Absence

Continuation of Coverage: Coverage may be continued for up to three years while you remain in employee status but receive no salary (limited to layoff or approved leave of absence). Arrangements for premium payment must be made with your personnel or payroll office prior to the time the layoff/leave of absence begins. A leave of absence is not considered ended until you have terminated employment or have resumed employment for at least 50% of what is considered your normal work time for that employer for 30 consecutive calendar days. If coverage is not continued during layoff/leave of absence, there are no continuation rights if employment terminates.

Reinstatement of Coverage: If your health coverage lapses during your leave or layoff due to non-payment of premiums, you must submit a new application either electronically or via paper within 30 days of returning to work to prospectively reinstate the lapsed coverage. 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. For more information, see Enrolling for Coverage FAQs Question: Are there other enrollment opportunities available to me after my initial one expires?

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 that occurs on or after the date the annuity application is approved by the Wisconsin Department of Employee Trust Funds (ETF), provided an application for health insurance has been received by that date either electronically or via paper.

If you occupy a seasonal or teaching 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.

Termination of Employment 

Coverage will end on the last day for which premiums are paid. 

For more information, see COBRA/Continuation of Health Coverage FAQs.

Appealing a Discharge

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 employer 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 the employer contribution will be refunded to you.

Retirement 

If your employer offers post-retirement health insurance payments and you are an employee who deferred coverage, you may enroll for coverage in the Local Access Plan 30 days prior to retirement in order to use post-retirement employer premium contribution. You must be insured in the Access Plan for one month before terminating employment.

If you are covered when you terminate employment to retire, your health coverage will automatically continue if your retirement annuity from the Wisconsin Retirement System begins or you take a lump sum benefit within 30 days of your employment ending. If you are eligible for Medicare, effective dates must be provided (Those eligible for Medicare and enrolled in the Local Access Plan or State Maintenance Plan (SMP) will be switched to Medicare Plus.). You must fill out the Local Employer Verification of Health Insurance Coverage (ET-4814) form and return it with your retirement application.

Note: If you are eligible for Medicare, you must be enrolled in the hospital (Part A), medical (Part B), and prescription drug (Part D) portions of Medicare at the time of your retirement.

Medicare Part D

While The Centers for Medicare and Medicaid Services (CMS) considers Part D voluntary, Medicare enrolled retirees will be automatically enrolled in the Navitus MedicareRx Prescription Drug Plan (PDP), which is underwritten by Dean Health Insurance Inc., a federally-qualified Medicare-contracting PDP. This is Medicare Part D coverage through an Employer Group Waiver Plan (EGWP) administered by Navitus Health Solutions, the Wisconsin Public Employers Group Health Insurance Program's pharmacy benefit manager. This replaces the commercial coverage provided by Navitus prior to the retiree being enrolled in Medicare. Supplemental wrap coverage is also included as a secondary benefit that pays when Medicare Part D coverage does not. Please see the Medicare Information FAQs 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).

A local employer may, at its option, pay all or a portion of the health and pharmacy benefit premium. If any portion of the premium is local employer paid, you must remit your portion of the premium directly to your former local employer. If/when your former local 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.

Rehired Retirees

2. How are my health benefits affected if I return to work for an employer not under the Wisconsin Retirement System (WRS)?

If you return to work for a non-WRS participating employer 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 (WRS)?

If you return to work for a WRS-participating employer, you may be eligible to once again become an active WRS employee. If you make this election and 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 Wisconsin Public Employers Group Health Insurance Program. Check with your employer to make sure you have other health insurance coverage available before you elect WRS participation.

You may also waive or terminate enrollment under Medicare until the first Medicare enrollment period after active WRS employment ceases. Your premium rates, while covered through active employment, will be the active employee contribution rates for your plan, not the Medicare rates.

When you subsequently terminate employment and resume your annuity, your eligibility for Wisconsin Public Employers Group Health Insurance Program coverage is once again dependent on you meeting the requirements for newly retired employees (that is, you must be insured under the Wisconsin Public Employers Group Health Insurance Program, and you must apply for an immediate annuity from the WRS).