ETF has updated the State Health Insurance Standards, Guidelines, and Administration Employer Manual (ET-1118), and has summarized the changes in the table below. Please disregard any previous versions of this manual.

Please note this major change: this manual no longer contains sick leave information. You can now find complete sick leave information in the new Sick Leave Conversion Program Employer Manual (ET-1170).

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 that when active employees enrolled in the HDHP plan, over age 65, and intending to retire they:

  • Should carefully consider when to begin their Social Security Administration (SSA) and Medicare Part A benefits 
  • Retroactive SSA and Part A benefits will require them to retroactively change from their HDHP plan. Further, HSA contributions become subject to tax penalties
 201B
Updated information: Employees can no longer receive SSA benefits and delay Medicare Part A 201B
Clarified language for when state employees terminate with at least 20 years of WRS creditable service and under MRA may enroll in the Group Health Insurance Program:
  • During annual open enrollment, or 
  • When beginning their annuity
 301B(4)
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 402C(2)
Modified language for changing participant’s gender of record 501C
Added language for employees who retire during or after open enrollment 601F
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 604
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
 703A
Clarified language for when an employee on a non-military leave of absence lapses versus terminates their coverage 704
Clarified language for when employees are terminated due to permanent layoff: employees are treated as terminated due to retirement or leave of absence, which enables them to continue health insurance coverage 706A(2)
Moved examples about contributions upon return from a leave of absence or temporary layoff from Chapter 12  708, 709
Clarified language for when employers may retroactively cancel coverage, which also applies to retired annuitants 801F
Clarified language that when an employee receives a disability annuity, they are considered to have met requirements for immediate annuity for health insurance purposes 1001B
Clarified language that COBRA qualified beneficiaries must be treated similarly to employees 1002
Entire chapter moved into new Sick Leave Conversion Program Employer Manual (ET-1170) Chapter 12
Updated Carrier Code list

Appendix B4

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