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Selecting a Health Plan

1. Can family members covered under one policy choose different health plans?

*No, for all employees and any retirees and continuants who have single or family coverage where all individuals either have or have no Medicare.

*Yes, for retirees and eligible continuants who have family coverage where at least one individual has Medicare and at least one does not. This is called a Medicare Some contract. For more information, see Medicare Advantage FAQs #14 under Enrollment.

2. My employer offers the Uniform Dental Benefit. Can I elect a family plan for medical and an individual plan under the Uniform Dental Benefit?

No. Uniform Dental coverage mirrors your health insurance coverage. For example, if you elect family health insurance coverage with dental, you will be enrolled in family Uniform Dental coverage.

3. Can I receive medical care outside of my health plan network?

This can be a concern for members who travel and those with covered dependents living elsewhere, such as a college student living away from home. Consider the following when selecting a health plan:

If you are covered through a Local Health Plan HMO, you are required to obtain allowable care only from providers within the HMO’s network. Local Health Plan HMOs will cover emergency care outside of their service areas, but you must get any follow-up care from in-network providers. Do not expect to join a Local Health Plan HMO and get a referral to a non-HMO physician. A Local Health Plan HMO generally refers out of network only if it is unable to provide needed care within its network.

If you are covered through a Preferred Provider Organization (PPO) such as the Access Plan, you have the flexibility to seek care outside a particular service area. However, out-of-network care is subject to higher deductible and coinsurance amounts.

Retirees Only:

IYC Medicare Advantage members have the freedom to choose any provider that accepts Medicare. IYC Medicare Advantage-PPO offers coverage for participants with Medicare Parts A and B and will pay the same cost-sharing within or out of network as long as the provider has not opted out of or been excluded from Medicare. Providers who are not eligible to participate in and/or have opted out of Medicare may only be paid for emergency care. For all other services done by a provider who is not eligible to participate in and/or has opted out of Medicare, you will be responsible for the full cost of services you receive. 

Medicare Plus members have the freedom to choose any provider. If you see a provider in the United States that has opted out of or been excluded from Medicare, benefits will be paid according to UnitedHealthcare's (UHC) usual, customary, and reasonable charges. This means you may pay a higher amount if the provider will not accept UHC's usual, customary, and reasonable amount as payment in full and, therefore, will not reimburse you the difference.

For services allowed in the Certificate of Coverage (ET-4113), Medicare Plus will pay providers worldwide. If you receive care outside of the United States, the provider may require that you pay for the cost of the services in full. Ask for a written, detailed bill or receipt showing the specific services provided to you in English. Send a copy of the itemized bill or an itemized receipt to UHC for reimbursement. 

For more information, see https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare.

4. How can I get a list of physicians participating in each plan?

Contact the plan directly or follow the instructions found on the 2025: Health Plan Search page by clicking on the health plan name. ETF and your benefits/payroll office do not have this information.

5. What steps should I follow to enroll in the health insurance program?

  • Determine which plans have providers in your area.
  • Contact the health plans directly for information regarding available physicians, medical facilities, and services. If your employer offers Uniform Dental, you must contact Delta Dental directly for information regarding the Uniform Dental Benefit and dental providers.
  • Review the health plan rates, report card information, and the 2025: Health Plan Search page.
  • To enroll, contact your payroll or benefits personnel for instructions. Retirees should file your Health Insurance Application/Change for Retirees (ET-2331) to ETF. Note: If you select family coverage, you must enroll all eligible dependents. 

6. Someone on my health plan is in the middle of medical treatment, and we have to change health plans. What do I need to do?

When you need to change health plans, and you or someone in your family is in the middle of medical treatment or has complex healthcare needs, you should keep a few things in mind when you make your health plan choice.

First, check the provider directories of the health plans you are considering, and try to find one with your doctor in network.

Next, contact the plan you have selected, and ask what their process is for transitioning your care. They may ask you to submit a form or to speak with someone in their care management team. 

If your new health insurance does not work with your doctor, but you are getting treatment for a serious condition, call your new health insurance company to let them know about your treatment. Depending on what illness or condition you are receiving treatment for, your new health insurance company may be able to work with your current doctor while you finish treatment. Be sure to tell your current doctor that you have a new health insurance.

New Employee Enrollment

7. When does my coverage take effect as a new employee?

If eligible, you may enroll for individual or family coverage in any of the available health plans without restriction or waiting periods for preexisting medical conditions, provided you file an electronic or paper health application with your benefits/payroll office within the required enrollment period stated below:

  1. Within 30 days of your date of hire in an eligible position. Coverage will take effect on the first day of the month on or following your hire date. You will have to pay the entire premium prior to becoming eligible for the employer's contribution share. Check with your payroll or benefits office to know when your employer contribution begins. Or,
  2. Within 30 days prior to the date that the employer contributes to the premium, with coverage taking effect when you become eligible for the employer contribution.
  3. You may also enroll during the annual open enrollment period for coverage to take effect on January 1 of the following year.

There are no interim effective dates, except as required by law. However, you may enroll for individual coverage within 30 days of your date of hire and change to family coverage if your electronic or paper application is received prior to the date the employer contributions begin.

If you cancel your policy prior to the date that the employer contribution starts, you may reenroll in health insurance, with the new coverage taking effect on the first day of the month that employer contribution begins.

You cannot assume that the month when your first payroll deduction occurs is the month when your coverage begins. For further information on deductions and coverage effective dates, contact your benefits/payroll office.

Important Information for Less Than Half-Time Employees:

The initial enrollment opportunity for most employees begins with their participation under WRS. However, if you are a less-than-half-time employee, you have another enrollment period if:

  1. There has been a 30-day termination of employment break; or
  2. Your hours of employment increase due to a change in your appointment, and you qualify for a higher share of employer contribution toward health insurance premiums; or
  3. You are appointed to a permanent position and now qualify for the full share of employer contribution.

If you apply for coverage within 30 days of one of these events, coverage will take effect on the later of the first of the month following your new hire date, or the date your are eligible for the increase in employer contribution. Retroactive effective dates are not allowed. This does not provide an opportunity to change from individual to family coverage.

You may also enroll during the annual open enrollment period for coverage to take effect on January 1 of the following year.

Other Enrollment Opportunities

8. Are there other enrollment opportunities available to me after my initial one expires?

You may be able to get health insurance coverage if you are otherwise eligible under specific circumstances as described below:

  • If you are an active employee and you and/or your dependents are not insured under the Wisconsin Public Employers Group Health Insurance Program because of being insured under another group health insurance plan, you may take advantage of a special 30-day enrollment period to become insured under the Wisconsin Public Employers Group Health Insurance Program if:
    • Your eligibility for that other coverage is lost involuntarily, or the employer's premium contribution for the other plan ends, or
    • You and/or your dependents lose medical coverage:
      • Under medical assistance (Medicaid); or
      • Upon return from active military service with the armed forces. Employees must return to employment within 180 days of release from active duty. You are entitled to enroll regardless of the coverage in effect. Coverage takes effect on the date of your reemployment, or
      • As a citizen of a country with national health care coverage comparable to the Access Plan

The enrollment period begins on the date the other group health insurance coverage terminates because of loss of eligibility (for example, termination of employment, divorce, expiration of COBRA, etc., but not voluntary cancellation of coverage or the loss of COBRA due to nonpayment of premiums) or the employer's premium contribution ends.

  • If you are currently enrolled in the Wisconsin Public Employers Group Health Insurance Program with individual coverage because your dependents are insured under another group health insurance plan, and eligibility for that coverage is lost or the employer's premium contribution for the other plan ends, you may take advantage of a special 30-day enrollment period to change from individual to family coverage. You must enroll all eligible dependents with the exception of adult child dependents (19 and older) who have other group health insurance coverage. Coverage will take effect on the date the other coverage or the employer's premium contribution ends.
  • If you are currently enrolled in the Wisconsin Public Employers Group Health Insurance Program with family coverage, during the annual open enrollment period you may request to provide coverage for your eligible adult child (19 or older) who is not currently insured. Coverage for your child will take effect on January 1 the following year. For more information, see the Dependent Information FAQs.
  • If you are not insured under the Wisconsin Public Employers Group Health Insurance Program and have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may enroll if coverage is elected within 30 days of marriage or 60 days of the other events. Coverage takes effect on the date of marriage, birth, adoption, or placement for adoption.
  • If you and/or your dependents lose medical coverage under the Children's Health Insurance Program (CHIP) or become eligible to participate in a premium assistance program, you will have an opportunity to enroll in the Wisconsin Public Employers Group Health Insurance Program without waiting periods for preexisting conditions. You can do this by filing an application either electronically or via paper within 60 days of the loss of eligibility or the date you become eligible for premium assistance and by providing evidence satisfactory to ETF.
  • If you do not enroll during a designated enrollment period, you may enroll for health insurance coverage, if you are otherwise eligible, during the annual open enrollment period.

Retirees only

The following former employees are eligible to reenroll during the annual open enrollment period, with coverage taking effect on January 1 of the following year:

  • You were insured immediately prior to termination of employment with a local employer who did and continues to participate in the Wisconsin Public Employers Group Health Insurance Program; and
  • You are receiving a WRS retirement annuity or received a lump-sum WRS retirement benefit that began within 30 days of termination of employment. 

Prospective retirees whose employer offers any post-retirement employer premium contributions such as accumulated sick leave credits to pay for insurance: If you are an employee who is not enrolled under the Wisconsin Public Employers Group Health Insurance Program as you near retirement, and you wish to enroll in order to use your employer post-retirement premium contributions to pay for health insurance in retirement, you must enroll in the Access Plan effective the first of the month prior to retirement. You must have 30 days of employee coverage prior to retirement.

Open Enrollment

The annual open enrollment period is the opportunity for eligible employees and retirees to select or change to one of the many health plans offered by the Wisconsin Public Employers Group Health Insurance Program. The following list contains some of the most commonly asked questions about the enrollment period. You can also find information about key terms in the Glossary of Health Coverage and Medical Terms. Additional medical definitions are found in the online Certificates of Coverage.

9. What is an open enrollment period?

The annual open enrollment period is an opportunity to change health plans, change from family to individual coverage, enroll if you had previously deferred coverage, cancel your coverage, or cancel the coverage for your adult dependent child (19 or older). It is offered only to employees, retirees, COBRA/continuants, and surviving spouses and dependents eligible under the Wisconsin Public Employers Group Health Insurance Program. Changes made take effect on January 1 of the following year.

Eligible retirees are those who are currently insured or were insured when they retired with an employer that offers the Wisconsin Public Employers Group Health Insurance Program. For more information, see Question #8 above.

10. May I change from individual to family coverage during the open enrollment period?

Yes. Coverage will take effect on January 1 of the following year for all eligible dependents.

Making Changes During Open Enrollment

11. How do I change health plans during open enrollment?

If you decide to change to a different plan, use the following instructions:

  • Active employees may download a paper application (ET-2301), or receive paper applications from your benefits/payroll/personnel office, to complete and return to that office. 
  • Eligible retirees and continuants may download a paper application (ET-2331), or contact ETF for a copy, and submit it to ETF.

Applications received after the deadline will not be accepted.

Note: If you plan to stay with your current health plan for next year, and you are not changing your coverage, you do not need to take any action.

12. How do I use the myETF Benefits website?

Refer to the myETF Benefits System Instructions.

13. What happens if I entered my changes online but did not submit them?

Your changes will not be stored unless you click the submit button. You will need to log back in and make the changes again. To view what you submitted, click the myRequests button at the bottom of the myInfo page.

14. What is the effective date of changes made during the open enrollment period?

Coverage changes take effect on January 1 of the following year.

15. What if I change my mind about the health plan I selected during the open enrollment period?

You may submit or make changes anytime during the open enrollment period, either online using the myETF Benefits website or by filling out a paper application. If you change your mind after that time, you may withdraw your application (and keep your current coverage) by following these instructions before December 31:

  • Active employees should inform their benefits/payroll office in writing; or
  • Insured retirees and continuants should notify ETF in writing.

Other rules apply when canceling coverage. For more information, see the Cancellation or Termination of Health Coverage FAQs.

16. Which other changes can be made during the open enrollment period if my health insurance premiums are taken pre-tax?

During the annual open enrollment period, you can add or drop coverage for yourself and/or your adult dependent children (19 or older), or do a spouse-to-spouse transfer of your health insurance coverage.

Retiree Enrollment

Important Note: If you are eligible/will become eligible for Medicare, you may also want to refer to the Medicare Information FAQs.

17. What happens to my health insurance when I become a retiree?

When you retire, your health insurance plan will automatically continue if your WRS retirement annuity begins within 30 days after your employment termination date. If you do not wish to continue coverage, you must notify ETF in writing.