Here you will find answers to frequently asked questions by Wisconsin Retirement System active employees and retirees about the impact of the global Coronavirus pandemic (COVID-19) on insurance benefits.
Q. My child turns age 26 soon. They had doctor appointments coming up that they had scheduled to attend before turning 26 and losing health insurance coverage under my plan . Those appointments have now been canceled due to COVID-19. Will my insurance extend their eligibility with my plan due to this crisis? (3/27/2020)
A. This would require a legislative change, and currently ETF is not aware of any such changes in progress. Coverage of an adult dependent who is not disabled ends at the end of the month in which they turn age 26. Depending upon the services needed, telehealth may be a good option that your child can access from home. Reach out to your health plan for details on what telehealth services are available to help meet needs.
Q. I would like to suspend my health insurance and not use my sick leave credits to pay the premiums since I must stay at home due to COVID-19 and will not be using my insurance. I want to be able to restart coverage once the Safer at Home order is over. Can I do that? (3/27/2020)
A.Health Insurance cannot be suspended and restarted at a different time. You can cancel coverage, but then would have to wait to sign back up for insurance during the annual open enrollment period or if you experience a qualifying life event that would make you eligible for health insurance. The 2020 open enrollment period will be September 28 to October 23. Coverage would be effective the following January 1, 2021.
Q: Does ETF have any advice regarding COVID-19 antibody testing? Will the testing be covered by insurance? (6/5/2020)
A: All group health insurance health plans will cover antibody testing under certain circumstances at no cost to members. We cannot guarantee that a health plan will reimburse for the services provided by a non-network third-party provider. The member should contact their health plan for specific information.
The FFCRA and CARES Act signed in March require all group health insurance plans to provide coverage at no cost for plan members. This includes “in vitro diagnostic tests,” which CMS indicates include serological/antibody tests. ETF-administered group health insurance health plans must follow this rule. However, plans can require that members seek care in network. If a member is seeking an antibody test, the best way to ensure this test will be covered at 100% is to contact their physician and discuss how to get tested. Members should contact their health plan for detailed cost information.
2019 Wisconsin Act 185 requires the State of Wisconsin Group Health Insurance Program (GHIP) to cover services provided out-of-network if a member is not able to receive those services in-network due to a surge in need. No GHIP health plans have indicated that they are unable to meet current capacity and statewide reported numbers indicate that all hospitals are able to meet current need. ETF at this point would not require plans to reimburse for these services out-of-network. If the health plan does reimburse for the test, they may reimburse whatever their usual and customary rate is for the service, which may be lower than the billed amount.
Finally, any testing that is required by an employer solely as evidence of disease state prior to return to work—either diagnostic or antibody—is not covered under the GHIP. Details are available in the Certificate of Coverage for each plan design .
Q: If an employer requires their employees to be tested for COVID-19 and they test positive or are asymptomatic, will insurance cover treatments? Would the test be considered elected versus necessary? (6/5/2020)
A: Testing that is required by an employer for return to work purposes is not covered by the group health insurance program. The employer must pay the entire cost of any employer-required tests.
If a member seeks a test from their physician as a part of a doctor’s visit (e.g., annual exam, problem-focused visit, visit for symptoms, etc.), those tests would be covered by the health plan.
If an employee tests positive but is asymptomatic, it is unclear what treatment they would be seeking. If the employee became symptomatic and needed to be hospitalized, etc., then those services would be covered under the health plan, regardless of who did the initial testing.
Health Insurance for State Employees
Q. Due to COVID-19, my spouse is laid off and we have lost our health insurance coverage insurance. I’m working at a state agency—can I waive my two months wait time for insurance? (4/1/2020)
A. You should contact your HR benefits specialist. Coverage can start within 30-days of hire, when you become eligible for employer share, or if there is a loss of other coverage event. You would have to pay the full premium without the employer contributions for the first two months.
Health Insurance for Retirees
Q. COVID-19 has impacted my income severely. May I delay/postpone my payments for several months and still be covered? If so, what are the ramifications if I choose to do so? If I choose to do this, what is the process I must perform? If I discontinue my coverage and later want to get back on again, am I allowed to do that?
A. If you are billed directly for your health insurance, please contact your health plan to discuss options for premium payment plans. Many health plans are working with members to offer this option during the pandemic. If you cancel coverage, you can re-enroll for coverage during the annual open enrollment period for coverage beginning January 1, 2021. The 2020 open enrollment period will be September 28 to October 23.
Q: Due to COVID-19, our employees are at home and do not have access to a printer to print and sign applications for supplemental dental and vision plans. Will it be acceptable to send a completed application without a signature? (4/8/2020)
A: Yes. Delta and VSP are accepting application forms without signatures from members at this time. If a member wants to directly email Delta or VSP their forms, they should call each vendor and let them know the form is coming and get the best email address to send the form to. That way, each vendor has on record they spoke to the member about the form. This offers coverage for a form with no signature.
Flexible Spending Account (FSA) for State Employees
Q. Regarding FSA rollover dollars that must be spent by March 31, is there any flexibility to extend the spend by date in case I do not get a chance to spend the rollover dollars due to COVID-19? (4/1/2020)
A. FSA rollover requirements are set by federal law, and so ETF cannot allow additional time to spend down funds. However, the recent CARES Act passed at the end of March allows additional items to be purchased with an FSA effective January 1, 2020. Please see this document from Connect Your Care, the state’s FSA vendor, for information on what you can use your FSA dollars on.
For Dependent Day Care Accounts, the IRS does not allow any carryover from prior year to current year; those funds must be used up each year. Participants have through March 31 to submit prior year day care expenses. Any day care contributions remaining are forfeited back to the employer.
Q. Will the life insurance policies pay death benefits if the person dies from COVID-19? (3/27/2020)
A. The State of Wisconsin Group Life Insurance Program does not contain any exclusions related to pandemics. The policy would pay a death benefit in the event of a death as a result of COVID- 19.
Sick Leave for Retirees
Q. Due to COVID-19, we are having a hard time making payments. We have Medicare and will not need the sick leave money to pay for insurance. Can we have the sick leave money paid out to us?
A. Accumulated sick leave credits have no monetary value. Therefore, they cannot be paid-out as cash. Sick leave credits can only be used to pay for health insurance premiums purchased through the State of Wisconsin Group Health Insurance Program.
Q. Would ICI provide benefits to me if I cannot work due to prolonged personal illness from COVID-19, if I need to care for a family member, or if I need to care for a child due to no day care options? (4/1/2020)
A. ICI will cover someone with prolonged illness due to the coronavirus, but it will not cover someone who is off work due to lack of childcare or to care for a family member who is ill.
Please contact your benefits or payroll office for eligibility information regarding the new federal leave options for employees unable to work because of illness, caring for an individual under quarantine, or for a child whose school or day care provider is closed or unavailable for reasons related to COVID-19.
Q: Will the federal stimulus check I receive be an offset to my Income Continuation Insurance benefit? (4/6/2020)
A: No. The stimulus checks do not fall under a category of income that can be offset.
Q: Will the federal stimulus check I receive be an offset to my Duty Disability benefit? (4/6/2020)
A: No. The stimulus checks do not fall under a category of income that can be offset.
A: No, the stimulus checks are not considered earnings and do not need to be reported to ETF when you submit the calendar year 2020 annual earnings statement in 2021.
Q: When will I get my annual 40.65 tax and income certification? (6/5/2020)
A: Normally this mailing goes out May 1, however, due to the pandemic and the IRS tax deadline extension to July 1, ETF expects to mail these out in early July.