Insurance Benefits 2025 Open Enrollment Information for Local Employers in the Program

The annual insurance benefits open enrollment period is September 30 - October 25, 2024.

This period allows uninsured but eligible employees and retirees to enroll for coverage effective January 1 of the following year. 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 submit their enrollment changes electronically via the myETF Benefits Online Health Insurance Enrollment System. Retirees may use myETF Benefits or complete the Health Insurance Application/Change for Retirees (ET-2331) form, which will be included in the 2025 insurance benefits decision guides mailed to retirees. 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 2025 in this bulletin for more information.

Note: If retirees are electing Medicare Some coverage, they must complete a paper application (ET-2331) and submit it to ETF.

If requested, the 2025 insurance benefits decision guides will be delivered to all employers at the end of September. The 2025 insurance benefits web pages will be available online for employers and members before the end of September. Visit etf.wi.gov for open enrollment information.

Please consider using the sample email at the end of this employer news to notify employees of open enrollment and important changes. To comply with federal notification requirements, see the Electronic Distribution information located in the 2025 Insurance Benefits Decision Guides Distribution section later in this bulletin. Since these web pages will not be available until the end of September, please do not send this email to your employees until mid-September.

Local Employer Open Enrollment Kickoff Meeting

Local Insurance Q&A Session

2025 Virtual Benefits Vendor Forums

Important Plan and Program Changes

Federal Section 1557 Non-Discrimination Information

General Open Enrollment Information

2025 Insurance Benefits Decision Guides Distribution

Employee Responsibilities

Additional Instructions and Information

Contacting the Health Plans

Sample Employee Emails

Local Employer Open Enrollment Kickoff Meeting

ETF will host two open enrollment employer kickoff events for local government employers for plan year 2025, and they will be held virtually. These events will follow a similar agenda as in previous years, and a recording will be available later on the ETF website for viewing anytime. 

See the previous employer news for more local employer information.

Session 1

• Date: Thursday, September 19, 2024
• Time: 1:00 p.m. - 4:00 p.m.
• Register: September 19 kickoff registration

Session 2

• Date: Tuesday, September 24, 2024
• Time: 9:00 a.m. - 12:00 p.m.
• Register: September 24 kickoff registration 

Employers must pre-register to attend these events online. Due to the high demand, please register as soon as possible.

The employer kickoff meeting provides an opportunity to hear from the health plans, pharmacy benefit manager, supplemental plans, wellness vendor (WebMD), and ETF employees about benefit program changes that are effective January 1, 2025. 

Local Insurance Q&A Session

ETF will host its annual local employer insurance question and answer session. All local employers may register to ask ETF staff any insurance (health, life, income continuation insurance) benefit-related questions. 
Employers must pre-register to attend this  event online via webinar. Due to the high demand, please register as soon as possible.

• Date:  Friday September 27, 2024
• Time:  9:00 a.m. - 11:00 a.m.
• Register:  Local insurance Q&A registration 

2025 Virtual Benefits Vendor Forums

ETF is hosting a series of virtual forums for employers and members to connect with benefits vendors during the 2025 open enrollment period. New this year, there will be evening sessions available from 5:00-6:30 p.m. for those who are not able to join during work hours. These virtual forums with the vendors will provide the same personal interaction with a vendor as a benefit fair or informational event from the safety of your own home or office. 

Additional details and registration information will be provided in the near future. Attendees must pre-register to attend these events online via virtual forums. Due to the high demand, please register as soon as possible.

Important Plan and Program Changes

Health Plan Changes 

Health Plan Name Change: Dean Health Plan - Prevea360 West and Mayo Clinic will now be known as Dean Health Plan - Medica West and Mayo Clinic Health System. 

The State Maintenance Plan (SMP) is offered by Dean Health Plan. Thirteen new counties are now SMP counties for 2025, designated with an asterisk (*) below. Two counties have been removed as SMP counties - Waupaca and Waushara. This growth in service area is due to the fact that several health plans qualified as Tier 1 plans in 2024 are no longer Tier 1 qualified in 2025. 

SMP is available in the following counties:

Benefit Changes 

Medical Benefit Changes: There are several medical benefit changes for plan year 2025, including:

• Expanded the lifetime limit on orthoptic eye training from two to no more than twelve. 
• Clarified nutritional counseling coverage. The certificate language was clarified to allow for nutritional counseling services related to weight management.

Active Employee 2025 Monthly Dental Rates

Retiree 2025 Monthly Dental Rates

Federal Section 1557 Non-Discrimination Information

Reminder: Please notify ETF of requests for insurance benefits information to be translated into languages other than English. Please share data about which information is being requested and in what language. Send to etfhealthandins@etf.wi.gov.

General Open Enrollment 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, 2024.

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. The 2025 plan pages under the Health Plan Search page will identify counties covered by each health plan, as well as a listing of their major providers and links to provider directories.

Retirees & COBRA/Continuants: ETF mails insurance benefits 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, 2025 or later, must complete their health benefits application as an active employee. Employees who will retire prior to January 1, 2025 should submit their application to ETF. Changes for retiree and continuant coverage are handled by ETF.

ETF has published the 88% premium rate tables. ETF does not publish the 105% rate tables on the website. Employers may request the 105% rate tables from ETF by email at etfsmbemployerinsurance@etf.wi.gov; 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 updated Group Health Insurance Application/Change (ET-2301) form can be downloaded from ETF’s website or you may order applications by completing the email form on the Employer Forms Order page on the ETF website. Local employer-paid annuitants should submit the Group Health Insurance Application/Change for Retirees (ET-2331) form, which will be available in the insurance benefits decision guide and on the ETF website.

2025 Insurance Benefits Decision Guides Distribution

The 2025 insurance benefits decision guides must be distributed in a timely manner to all employees. The distribution method (hard copy, link to web version, or PDF file) is determined by the employer. It is acceptable for employers to distribute decision guides using an electronic method. Employee distribution should include: 

• Employees who have indicated they do not wish to make a change during the annual open enrollment period.
  • Remind these employees that they remain responsible for understanding the information contained in the 2025 insurance benefits decision guides and on the ETF website, and that their certificate of coverage and schedule of benefits are available on the ETF website. We encourage you to point employees to the enrollment checklist on the inside cover of the insurance benefits decision guide for important reminders. 
• 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 2025 Insurance Benefits Decision Guides

Employers distributing open enrollment 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 open enrollment 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: Distributing links to web versions or PDF files of the insurance benefits decision guides is acceptable. However, if employees do not have access to a computer and/or request a paper copy, they must be given one.

Employee Responsibilities

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.

Processing Changes

Employers are responsible for keying changes submitted on paper by using the myETF Benefits system found through the Online Tools link found on the ETF website by November 15, 2024. 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 2025 to continue their current health insurance.

Employer’s Application Processing Instructions

During the open enrollment period, employers have three options for handling requests from their employees:

1. 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, 2024. ETF strongly encourages employers to direct their employees to use the myETF Benefits system.
2. Retirees may use myETF Benefits or complete the Health Insurance Application/Change for Retirees (ET-2331) form, which will be included in the 2025 insurance benefits decision guide. Retirees electing Medicare Some coverage must complete and submit a retiree application (ET-2331) to ETF by October 25, 2024.
3. 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, 2024. If an employer elects to require a paper application, the employer must enter that application on behalf of their employee into the myETF Benefits Administrator for Employees system found under Online Tools on the Employers page of the ETF website. The application is not to be mailed or faxed to ETF for processing and keying in. The deadline for employers to enter health benefits applications into the myETF Benefits system is November 15, 2024.
   1. 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.

In summary, 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. The application may be signed electronically, as long as the employer can verify the signature. A secure email from the employee stating their intent to apply for health insurance or change their coverage along with a complete health insurance application provided to ETF in the normal manner is acceptable in lieu of a signature.
• 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, 2024, must be keyed into the myETF Benefits system by November 15, 2024. This deadline must be met by the employer to ensure health plans and Navitus receive the contract information timely. This ensures that employees receive their health plan information and identification cards prior to January 1, 2025. 

Withdrawing/Rescinding a Health Benefits Application

An employee’s request to withdraw or rescind a health benefits application must be entered into myETF Benefits by ETF. Employees may rescind a 2025 application by notifying their employers in writing prior to December 31, 2024. The written request should be filed with the employee’s records. Forward one copy of the employee’s written request to rescind to ETF. ETF will update myETF Benefits by deleting the request and reinstating the employee’s original coverage.

An employee may also rescind their request by writing “Rescind” across the top of their original application and initialing it. Forward a copy of this updated application to ETF for processing and keep a copy for the employee’s file. ETF will update myETF Benefits by deleting the request and reinstating the employee’s original coverage.

Additional Instructions and Information

Specific instructions are found in the Local Employer Health Insurance Standards, Guidelines and Administration Manual (ET-1144), including:

• Information on what to do if you have an employee initially eligible for coverage in November or December.
• Instructions on completing the COBRA Continuation - Conversion Notice (ET-2311) if you have an employee who terminates employment in November or December after filing a health benefits application.
• Information on the process to follow if you receive a late application, an application received after the last day of the open enrollment period. ETF reviews all late requests. Note that documents for late 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 etfhealthandins@etf.wi.gov.

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 for members that will be available on the updated health plan pages soon and on the back cover of the decision guides. These customer service lines are fully staffed to handle call volume. 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 insurance benefits information to your employees. You may want to provide a link to your program option’s decision guide.

Important Information about Your Insurance Benefits for 2025

The annual open enrollment period, which begins on September 30 and ends on October 25, 2024, 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.)
• Enroll in supplemental dental coverage. (Employer, reminder you must opt in to the Supplemental Dental Program before your employees can register for it. Strike this line from your email if you are not opting in to the program.)
• Enroll in supplemental vision coverage. (Employer, reminder you must opt in to the supplemental vision benefit before your employees can register for it. Strike this line from your email if you are not opting in to the program.)
• Enroll in the Securian Accident Plan. (Employer, reminder you must opt in to the Securian Accident Plan before your employees can register for it. Strike this line from your email if you are not opting in to the program.)

Changes you make during open enrollment become effective January 1, 2025.

Your To-Do List:
Visit etf.wi.gov for information about your 2025 benefits.

• Attend a benefit vendor forum. ETF will host a number of forums during the open enrollment period for you to learn about the 2025 plan year. You’ll have the opportunity to ask questions directly to health plans and vendors. Visit etf.wi.gov/insurance to register. 
• The deadline to submit your electronic request or your completed paper application to your benefits office is 4:30 p.m. on October 25, 2024. (Employer, replace this bullet with information about your electronic enrollment system, and/or alter the deadline time if your office is open later.)

Language assistance is available.