ETF has updated the Local Employer Health Insurance Standards, Guidelines, and Administration Employer Manual (ET-1144), and has summarized the changes in the table below.  Please disregard any previous versions of this manual.

If you have any employer related questions regarding the group health insurance program, please contact Employer Communication Center at ETFSMBEmployerInsurance@etf.wi.gov or 1-877-533-5020.

Summary of Change Location
Clarified language for the procedure in rare situations where an employer offers more than one Program Option for employees and an employee switches from one to another due to a position change 201C
Clarified language for when new employers join the Wisconsin Public Employers Group Health Insurance Program, employees must enroll in the Access Plan if they meet certain conditions 303A
Clarified language for if an employee wants to drop due to enrollment in Medicaid or Tricare, they need to provide information on how much the coverage premiums cost 502C(2)
Modified language for changing participant’s gender of record 601C
Added language for the reenrollment of certain retirees with eligibility for post-retirement benefits that pay for health insurance premiums 608
Added language for employees who retire during or after open enrollment 701F
Added language for late open enrollment applications: Employers do not need to submit late applications to ETF as long as "open enrollment" reason remains available in MEBS; employers can continue to key applications 704
Clarified language for coverage during leave of absence: When an employer pays its employer share of the premium, but an employee does not pay its employee share of the premium
  • Coverage continues for that first month after the employee hasn't paid
  • Coverage terminates the next month for failure to pay
 802
Clarified language for when an employee on a leave of absence lapses versus terminates their coverage 803
Clarified language when employees on layoff return to work 804
Clarified language if an employee fails to notify their employer of a divorce:
  • Coverage terminates for the ex-spouse last day of the month when COBRA notification occurs
  • The employer may collect premiums retroactively from the subscriber that failed to notify in a timely manner
 901A 10
Clarified language for when employers may retroactively cancel coverage, which also applies to retired annuitants 901G
Clarified language that COBRA qualified beneficiaries must be treated similarly to employees 902
Clarified language that when an employee receives a disability annuity, they are considered to have met the requirements for an immediate annuity for health insurance purposes 1101B
Updated Carrier Code list

Appendix B6

Note: Updated 6/1/2023
Updated health insurer name changes Various
Updated text about Certificates of Coverage and Schedules of Benefits Various
Clarified language for when employees gain eligibility to employer contributions to premiums due to position changes greater than 49% FTE:
  • Application must be received within 30 days of change
  • Coverage becomes effective the first month following the position change
 Various
Added language for required documentation for single parents to provide to cover dependents Various
Clarified language that expiration of COBRA is a qualified loss of coverage reason that creates an enrollment opportunity; This does not include loss due to non-payment of premium Various
Clarified that "HIPAA Qualifying Event" means a "Life Event" Various