It’s Your Choice Open Enrollment is September 30 - October 25, 2019.
The annual health benefits open enrollment allows uninsured but eligible employees and retirees to enroll for coverage effective the following January 1. In addition, this is an opportunity for currently insured subscribers (active employees, retirees and continuants) to change health plans, enroll or remove adult children from family coverage, change from individual to family coverage, change from family to individual coverage or cancel coverage.
We encourage employees and retirees to electronically submit their enrollment changes via the myETF Benefits Online Health Insurance Enrollment System. Retirees may use myETF Benefits or complete the Health Insurance Application/Change for Retirees and COBRA Continuants (ET-2331) form, which will be included in the It’s Your Choice Decision Guide. Employees will find step-by-step information on how to submit an electronic request on ETF’s website. Please see the Employer’s Application Processing Instructions for It’s Your Choice 2020 later in this bulletin.
Note: If retirees are electing Medicare Some, they must complete a paper application ET-2331) and submit it to ETF.
The It’s Your Choice decision guides will be delivered to all employers at the end of September. Up-to-date and easily accessible, interactive information will be available in the 2020 health benefits pages, which will be available online at etf.wi.gov/benefits-by-employer – which will go live and be available to employers and members at the end of September.
Please consider using the sample email below to notify employees of open enrollment and important changes. To comply with federal notification requirements, see the Electronic Distribution of the It’s Your Choice guides section later in this bulletin. This sample email contains direct links to where members will be able to find 2020 information; since these webpages will not be available until the end of September, please do not send this email to your employees until the last week of September.
It’s Your Choice Employer Kick-Off Meeting Reminder
Reminder! Attend the It's Your Choice 2020 employer kickoff meeting to get important health news and a preview of 2020 health benefits materials.
Employers have the option to attend one of four kick-off meetings held throughout the state. See the previous employer news for more local employer information.
Pre-registration is not required to attend in person. However, employers must register to view the meeting online via webinar. Due to the high demand, please register as soon as possible.
The It’s Your Choice employer kick-off meeting provides an opportunity to receive information from representatives from the health plans, pharmacy benefit manager, supplemental plans, wellness vendor (StayWell) and ETF employees regarding benefit program changes effective January 1, 2020.
Note: ETF will not have paper decision guides at the event.
Important Plan and Program Changes
Plan and Network Changes
No Longer Available
- Security Health Plan - Central
- Security Health Plan - Valley
If an employee is currently enrolled in one of these health plans, they must enroll in a new plan during open enrollment. If they do not, they will not have coverage as of January 1, 2020. Provider directories will be available on our website.
Service Area Changes
Dean Health Plan - Prevea360 will expand to include the following western counties: Barron, Buffalo, Chippewa, Dunn and Eau Claire. Prevea360 will also offer limited provider availability in Pepin County.
WEA Trust - East will expand to include the following counties: Langlade, Lincoln, Oneida, Price, Taylor and Vilas. WEA Trust - East will also offer limited provider availability in Forest County.
Network Health will expand to include Marathon County.
The State Maintenance Plan (SMP) will no longer be available in the following counties: Buffalo, Marinette, Polk, Shawano, St. Croix, Waupaca, Waushara and wood.
SMP will continue to be offered in the following counties: Florence, Forest, Pepin, Pierce, and Rusk. Employees should make sure their providers are in-network or select another plan. The provider directory will be available on the ETF website.
Vaccines at Pharmacies Covered
Vaccines will be covered under the pharmacy benefits at in-network retail pharmacies. Participants can find an in-network pharmacy at etf.benefits.navitus.com (no login required).
Participants can still choose to get vaccines through their medical provider instead, which will be covered under the medical benefits.
New Medical Benefit Changes
Bariatric surgery and weight loss services will be provided for participants with a body mass index (BMI) of 35 or greater, or as determined by the health plan.
New Enrollment Options for Retirees
Families with Medicare and Non-Medicare Members
When a Retiree enrolls in Medicare Advantage or Medicare Plus, they can enroll in a second health plan for their non-Medicare family members. This option may help them save on monthly premiums.
New Life Event for Retirees
When an employee or someone on their health insurance becomes eligible for Medicare or no longer eligible, they can choose a new health plan or plan design. They must file an application within 30 days of the Medicare coverage change. This is not an opportunity to enroll.
Uniform Dental Benefits
New benefits include:
- No-cost periodontal maintenance (special cleaning procedure for those with periodontal disease; helps maintain gum and bone health)
- Pulp-vitality test (helps a dentist determine a treatment plan)
- Caries assessments (helps predict future dental health)
Local employees and retirees will be now eligible to select supplemental dental benefits in 2020. These plans can be purchased in conjunction with most other medical and dental plans.
Three offerings will be available through Delta Dental of Wisconsin:
- Delta Dental PPO Plus Premier – Preventive Plan
100% coverage for routine evaluations and cleanings as well as other diagnostic, preventive and basic services including fillings, sealants, X-rays, fluoride, orthodontics (up to $1,500 maximum) and more. Those enrolled in the Uniform Dental Benefit are not eligible. Benefit is available through the Delta Dental PPO and Delta Dental Premier networks.
- Delta Dental PPO – Select Plan
Provides coverage for major and restorative services like crowns, bridges, dentures, and root canals at 50%. Benefit is available through the Delta Dental PPO network only.
- Delta Dental PPO Plus Premier – Select Plus Plan
Covers major and restorative services at 60-80% and includes an additional $1,500 orthodontic benefit. Benefit is available through the Delta Dental PPO and Delta Dental Premier networks.
More information will be provided in future updates at www.deltadentalwi.com/state-of-wi and www4.deltadentalwi.com/state-of-wi/hr-managers. Employers must opt-in during open enrollment to offer this benefit to active employees. Local WRS retirees are eligible for supplemental dental coverage even if their former employer doesn't opt into the program. If you have questions, please contact ETFsales@deltadentalwi.com.
Well Wisconsin and Staywell®
The deadline to earn the 2019 Well Wisconsin incentive is October 11, 2019. Incentives earned by October 11, 2019 must be claimed in the StayWell wellness portal by October 25, 2019. Participants may choose to have the $150 gift card sent to their email or by postal mail to their home address.
Note: In preparation for the 2020 program year, the StayWell wellness portal will not be available from December 20, 2019 through the first week of January 2020.
The 2020 Well Wisconsin incentive will continue to be available through StayWell to enrolled employees and their enrolled spouse.
New for 2020: StayWell will have a new online platform with new resources available. The website, wellwisconsin.staywell.com will remain the same. To earn the $150 in 2020, participants must create a new portal account, complete a health screening, health assessment and well-being activity through StayWell. If participants do not use a computer or smart phone, they may call StayWell at 1-800-821-6591 to request to complete the activities via paper. StayWell will send mailers to all eligible households in early 2020 with additional program information.
StayWell will begin taking requests from employers for 2020 on-site health screening events in mid-November 2019. The earliest date employers may hold a 2020 event is February 3, 2020 due to the portal availability date of early January.
Federal Section 1557 Non-Discrimination Information
Reminder: Please notify ETF of requests for health benefit information to be translated into languages other than English. Please share data about which information is being requested, in what quantities, and in what language. Send to email@example.com.
Income Continuation Insurance Update:
Updated contact information for the plan administrator, The Hartford, is below:
Toll Free: 1-800-960-0052
P.O. Box 14869
Lexington, KY 40512-4869
The local ICI brochure has been updated.
General It’s Your Choice Information
To change health plans or coverage levels or decline dental coverage, employees must submit a completed electronic or paper health insurance application to their employers no later than Friday, October 25, 2019.
Employees may select any health plan regardless of their county of residence, but should consider whether the providers are within a reasonable distance for medical care. An interactive map online will be available in the 2020 health benefits information and identifies geographic areas covered by each health plan, as well as their major providers and provider directories.
ETF mails It’s Your Choice decision guides directly to retirees and former employees who have continued their health insurance coverage. Employees who wish to change health plans and who will retire effective January 1, 2020 or later, must complete their health benefits applications as active employees. Changes in annuitant coverage are handled by ETF when the employee applies for retirement benefits.
Beginning this year, ETF will not publish the 105% rate tables on the website. Employers may request the 105% rate tables from ETF; be prepared to discuss which employee group you are using the rates for as these rates should only be used for Public Safety Employees (and their management) under a valid collective bargaining agreement. The 88% rate tables will be published prior to open enrollment.
The updated Group Health Insurance Application/Change (ET-2301) form can be downloaded from ETF’s Internet site or you may order applications by completing the Online Forms Order page found on the employer forms page on the ETF website. Local employer-paid annuitants should submit the Group Health Insurance Application/Change for Retirees and COBRA Continuants (ET-2331) form, which will be available on the ETF website.
It’s Your Choice Guides Distribution
It’s Your Choice guides must be distributed in a timely manner to all employees, including:
- Employees who have indicated they do not wish to make a change during the It’s Your Choice open enrollment period.
Remind these employees that they remain responsible for understanding the information contained in the It’s Your Choice guides and on the ETF website, and that their certificate of coverage is available on the ETF website. There's a new shortened checklist in the guides for employees who don't want to make changes. We encourage you to point employees there.
- Insured employees on temporary layoff or leave of absence and those on permanent layoff paying premiums through the employer.
Employees who allowed health insurance coverage to lapse while on a leave of absence or a temporary layoff that encompassed the entire open enrollment period should be advised they are eligible to make a health benefits election within 30 days of returning from the leave or layoff.
Electronic Distribution of the It’s Your Choice Guides
Employers distributing the It’s Your Choice information electronically must incorporate the following as part of their electronic distribution procedures:
- Develop a list of all eligible employees and use that list to match against their file of employee email addresses.
- Verify the list and then send the employee an email (see sample email below) with the link to the guides and online information. Employers should send the email with a “return receipt.” This will establish a record of when the employee opened the email.
- Due to federal regulations, employers must retain the list of employees who received an electronic copy of the IYC materials. For each employee who is sent an email message, the employer should receive a “reject” notice if the email address is no longer in existence.
Note: ETF recommends that you give new employees paper copies of the guides. In addition, employees who do not have access to a computer and employees who receive the electronic distribution but request a paper copy, must be given one.
Employees must contact health plans directly to request the most up-to-date information regarding service area and/or provider availability related to open enrollment.
Note: When contacting a health plan or Navitus, employees must identify themselves as a Wisconsin Public Employer Group Health Insurance Program subscriber in order to receive information pertinent to the program administered by ETF. It’s also beneficial if they state which program option they are offered; please provide this information to employees.
Health plans often report they are unable to contact current subscribers due to incorrect addresses on file. Please remind employees who participate in the group health insurance program that they are responsible for providing address changes and revisions of other relevant information, such as marital status changes, to you via a myETF Benefits update or the Group Health Insurance Application/Change (ET-2301) form.
Employers are responsible for keying changes submitted on paper by using the myETF Benefits system found on the Online Network for Employers (ONE) Internet site by November 15, 2019. Once mailing addresses are updated, employees will receive provider information in a timely fashion, including information for the annual disabled dependent verification process, which enables dependents who remain eligible in 2019 to continue their current health insurance.
Note: If retirees are electing Medicare Some, they must complete a retiree paper application (ET-2331) and submit to ETF.
Employer’s Application Processing Instructions for It’s Your Choice
During the open enrollment period, employers have three options for handling requests from their employees:
Employers can require employees to use the Online Network for Members (ONM) site to file their requests through the myETF Benefits system. Employees must submit their electronic request no later than October 25, 2019. ETF strongly encourages employers to direct their employees to use the myETF Benefits system. Retirees may use myETF Benefits or complete the Health Insurance Application/Change for Retirees and COBRA Continuants (ET-2331) form, which will be included in the It’s Your Choice Decision Guide.
Employers may require employees to file their requests by completing a Group Health Insurance Application/Change (ET-2301) form and submit the application to the employer no later than the end of the business day on October 25, 2019. If an employer elects to require a paper application, the employer must enter that application into the myETF Benefits system on behalf of their employee on the ONE site. The application is not to be mailed or faxed to ETF for processing and keying. The deadline for employers to enter It’s Your Choice applications into the myETF Benefits system is November 15, 2019.
If the employee submits a paper application to their employer, ETF does not require that a copy of the application be submitted to ETF. Employers are not to make entries on behalf of their employee without an application as documentation of the employee’s request. The employer is to maintain a copy of the paper application in the employee’s file.
Either accept an electronic request from an employee or a paper Group Health Insurance Application/Change (ET-2301) form. Again, this is at the employer’s discretion to determine what will be acceptable.
If employers are going to accept a Group Health Insurance Application/Change (ET-2301) form, the following steps in processing the application are required:
- Verify the employee completed the application in its entirety, including signing the application. The application should be promptly returned to the employee if it is incomplete.
- Complete the employer section of the application in its entirety. Do not leave requested information blank.
- Return a completed copy of the application to the employee. Do not send a copy of the application to ETF or the health plan.
- All Group Health Insurance Application/Change (ET-2301) forms received by the employer on or prior to October 25, 2019 must be keyed into the myETF Benefits system by November 15, 2019. This deadline must be met by the employer to ensure health plans and Navitus receive the contract information timely so employees receive their health plan information and identification cards prior to January 1, 2020.
Note: If retirees are electing Medicare Some, they must complete a paper application ET-2331) and submit it to ETF.
Withdrawing/Rescinding an It’s Your Choice Application
Entry into myETF Benefits of an employee’s request to withdraw or rescind a health benefits application must be completed by ETF. Employees may rescind a 2020 application by notifying their employers in writing prior to December 31, 2019. The written request should be filed with the employee’s records. When you receive a request to rescind, make two copies of the application initially submitted by the employee to select a change and write “Rescind” across each copy. Forward one copy of the application along with a copy of the employee’s written request to rescind to ETF. If the employee enrolled through an employer’s human resources benefit application, a copy of the enrollment screen must be submitted, with “Rescind” across the top and initialed by the employee. Retain a copy for your employee’s records. ETF will update myETF Benefits by deleting the request and reinstating the employee’s original coverage.
If an employee submitted his/her request through the myETF Benefits system and now wants to rescind that request, the employee must submit a written request to their employer by December 31, 2019. Employers are to make a copy of that written request and forward it to ETF while retaining a copy for your employee’s records. ETF will update myETF Benefits by deleting the request and reinstating the employee’s original coverage.
Additional It’s Your Choice Instructions and Information
Specific It’s Your Choice instructions are found in the Local Employer Health Insurance Standards, Guidelines and Administration Manual (ET-1144):
Information if you have an employee initially eligible for coverage in November or December.
Instructions on completing the Continuation - Conversion Notice (ET-2311) if you have an employee who terminates employment in November or December after filing an It’s Your Choice application.
Information on the process to follow if you receive a late It’s Your Choice application, an application received after the last day of the It’s Your Choice open enrollment period. ETF reviews all late It’s Your Choice requests. Note that documents for late It’s Your Choice applications can be faxed to 1-608-266-5801, attention Employer Services.
Contact the Employer Communication Center at 1-877-533-5020 with questions or via email at firstname.lastname@example.org.
Contacting the Health Plans
The updated Health Plan Contact List (ET-1728) is meant for employers to use when contacting the health plans for assistance with membership, supplies, etc. The contact list includes email addresses and fax numbers when available.
Note that employees who need assistance should contact the health plan directly, using the health plan contact information available on the ETF website. These are customer service lines and are fully staffed to handle a large number of phone calls. Employees should specify they are enrolled in the Wisconsin Public Employers Group Health Insurance Program when calling the health plans.
Sample Employee Email
You can use the below sample email to provide It’s Your Choice information to your employees:
Important Information about Your Health Benefits for 2020
The It's Your Choice open enrollment period, which begins on September 30 and ends on October 25, 2019, is right around the corner.
This is your chance to:
Enroll or make changes to your health insurance.
Add or decline Uniform Dental (Employer, if you offer Uniform Dental Benefits include this bullet. Strike it from your email if you do not offer Uniform Dental Benefits.)
New: Enroll in supplemental dental coverage. (Employer, reminder you have to opt into the Supplemental Dental Program before your employees can register for it. Strike this line from your email if you are not opting into the program.)
Changes you make during open enrollment become effective January 1, 2020.
Your To-Do List:
Visit etf.wi.gov/benefits-by-employer for information about your 2020 benefits.
View Important Changes for 2020 to learn about changes that may impact you in the upcoming plan year.
The deadline to submit your electronic request or your completed paper application to your benefits office is 4:30 p.m. on October 25, 2019. (Employer, replace this bullet with information about your electronic enrollment system, and/or alter the deadline time if your office is open later.)