ETF has updated the State Health Insurance Standards, Guidelines, and Administration Employer Manual (ET-1118). Please disregard any previous versions of this manual.
| Location in Manual | Summary of Change |
|---|---|
| 201B 2.b | HDHP information updates: In order to treat all retirees with Medicare Some contracts the same, non-Medicare retirees who insure a dependent with Medicare can only select the non-HDHP plan. This matches the current practice where retirees with Medicare cannot select the HDHP due to disqualifying other coverage. |
201B 2.b 3, & 801G | HDHP: Clarifies that for employees who have disqualifying coverage that pays medical and/or drug benefits before the deductible and OOP costs, like Tricare: If the other disqualifying coverage is effective in the current year, their HDHP plan must change to a non-HDHP plan with the same vendor when the other coverage begins. If the disqualifying coverage was found to be effective in a previous calendar year, their HDHP is retroactively canceled to 1-1 of the current year. Retroactive changes impact premiums, claims, and HSA contributions. |
| 201B 5a, 5b | HDHP: Clarifies information for employees who retire and are over the Social Security Administration’s (SSA) full retirement age (e.g. age 65) about stopping their HSA contributions in advance of retirement. The employer may want to direct employees to the Frequently Asked Questions in the HSA section, question 16 and the Medicare Eligibility Statement (ET-4307). ETF cannot offer tax advice. |
| 207, 1201F 4 | Updates name of Navitus' plan for retirees to the "Medicare Pharmacy Part D" plan. |
| 301A 3 | Clarifies that employees of the legislature and blind employees of Beyond Vision are eligible for all insurance, including income continuation insurance, regardless of their Wisconsin Retirement System eligibility status. |
| 303A) 3 | Clarifies example with "Becca" to read that if an employee enrolled under GA coverage becomes eligible for and enrolled in any WRS position, they cannot retain GA coverage. |
| 305C | Clarifies that there must be continuous coverage for an employee who is experiencing a job transfer with a work break of 30 days or less. If the termination happens across two months (e.g. termination in late October, transfer/rehire in early November) the person gets employer contribution from their new employer on the first of the month so there is no gap. This occurs instead of the effective date being the first of the following month. |
| 402C | Clarifies that ETF will permit a subscriber to drop a spouse if the spouse lives and works out-of-state and has other coverage through employment that results in claims issues with the Group Health Insurance Program (typically HDHP with HSA). Documentation required. |
| 503B | Updates that effective 1/1/2024, for retirees who wish to change health plans when they or a dependent gains Medicare, or when an employee or their dependent gains Medicare while the employee retires and wants to change plans, the effective date will be the first of the month following ETF's receipt of an application, or the date they enroll in BenefitPlace. |
| 507J | Clarifies documentation requirements for a custody change when a subscriber requests to remove a dependent. |
| 601E | Corrects application instructions to inform employees to check the "Annual health benefits enrollment" box on the application, not the "It's Your Choice" box. |
| 1001C, 1001D | Updates reflect new and updated forms. State employees with 20 or more years of creditable service, upon termination, should complete the new Group Health Insurance Program Continuation Application (ET-2155), not the COBRA Continuation - Conversion Notice (ET-2311). |
| 1201G | Clarifies instructions regarding Medicare Data Match (collection) inquiries from the U.S. Department of Treasury. The employer should make sure the health plan's Coordination of Benefits (COB) person is working the case as priority.; the employer may not need to send a letter to Treasury. |
| 1302B | Corrects reference at the end of paragraph to read "1302D". |
| Appendix B 4) | Updates the Health Plan/Carrier Code table for 2024. |
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.