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Wisconsin Retirement System
Local Health Insurance Administration Manual
ET-1144, Rev. 7/2005
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TABLE OF CONTENTS
PREFACE
CHAPTER 1 -- GENERAL INFORMATION
- 101 Introduction
- 102 Employer Responsibilities
- 103 Health Insurance Portability and Accountability Act (HIPAA)
- 104 ETF Ombudsperson Services
- 105 Insurance Complaint Form (ET-2405)
- 106 Employer Withdrawal From the Group Health Insurance Program
- 107 Internet Address – http://etf.wi.gov
- 108 Administrative Offices
- 109 Employer Forms
CHAPTER 2 – HEALTH PLAN AND
PROGRAM INFORMATION
- 201 Alternate Health Plans (HMOs)
- 202 Standard Plan
- 203 State Maintenance Plan (SMP)
- 204 Program Options
- 205 Pharmacy Benefit Manager (PBM)
- 206 Health Plan Contacts
- 207 Coordination of Benefits (COB)
CHAPTER 3 – ELIGIBILITY,
INITIAL ENROLLMENT AND COVERAGE INFORMATION
- 301 Coverage Eligibility
- 302 Employer Premium Rate Contributions
- 303 Initial Enrollment and Effective Dates
- 304 Declining Coverage
- 305 Enrollment Opportunities for Employees who Previously Declined/Cancelled
Coverage
- 306 Completing the Group Health Insurance Application (ET-2301)
- 307 Group Health Insurance Application (ET-2301)
- 308 Identification (ID) Cards
- 309 Coverage During Leave of Absence
- 310 Coverage During Layoff
- 311 Coverage During Appeal of Discharge
CHAPTER 4 – CHANGES TO ENROLLMENT
AND COVERAGE
- 401 Dual-Choice Enrollment
- 402 Withdrawing Dual-Choice Elections
- 403 When a Health Plan Is Not Available at Dual-Choice
- 404 Late Dual-Choice Applications
- 405 Dual-Choice Review Sample Letter
- 406 Switching Health Plans Following Residential Move
- 407 Adding/Deleting Dependents
- 408 Completing the Health Insurance Information Change Form
(ET-2329)
- 409 Health Insurance Information Change Form (ET-2329)
- 410 Changing from Active to Annuitant Coverage
- 411 Voluntarily Canceling Coverage
- 412 Enrollment/Coverage Change Effective Date Reference Chart
CHAPTER 5 – MONTHLY REPORTING
– ACTIVE EMPLOYEES
- 501 Overview of Monthly Reports
- 502 Completing the Monthly Additions Report (ET-2610)
- 503 Completing the Monthly Deletions Report (ET-2612)
- 504 Completing the Monthly Changes Report (ET-2614)
- 505 Completing the Monthly Coverage Report
- 506 Completing the Health Insurance Summary
- 507 Assembly of Health Insurance Reports
- 508 Premium Remittance
- 509 Credits
- 510 New Employer Surcharge
- 511 Surcharge Monthly Reports
CHAPTER 6 – MONTHLY REPORTING
– EMPLOYER-PAID ANNUITANTS
- 601 Definition of Employer-Paid Annuitant
- 602 Overview of Monthly Reports
- 603 Completing the Group Health Insurance Transfer Report (ET-1615)
- 604 Completing the Monthly Coverage Report
- 605 Completing the Health Insurance Summary
- 606 Employer-Paid Annuitant – Medicare Reporting Requirements
- 607 Subscriber Ceases to be an Employer-Paid Annuitant
CHAPTER 7 – COBRA, CONTINUATION
AND CONVERSION
- 701 Overview of COBRA, Continuation and Conversion
- 702 Persons Eligible for Continuation (Qualified Beneficiaries)
- 703 Employee/Qualified Beneficiary Responsibilities
- 704 Employer Responsibilities
- 705 Notice Requirement Illustration Chart
- 706 Continuation Coverage Information
- 707 Instructions on Completing the Continuation-Conversion
Notice (ET-2311)
- 708 Sample Continuation-Conversion Notice Form (ET-2311)
CHAPTER 8 – RETIREMENT, DISABILITY
OR LONG-TERM DISABILITY INSURANCE
- 801 Coverage – Requirements to Continue
- 802 Medicare Enrollment
- 803 Completing Employer Verification of Health Insurance Coverage
(ET-4814)
- 804 Annuitant Premium Payments
- 805 Reporting a Retiring Employee Who Is Not an Employer-Paid
Annuitant
- 806 Canceling Coverage
CHAPTER 9 – REHIRED ANNUITANTS
- 901 Eligibility
- 902 Coverage
- 903 Disability Annuitants
CHAPTER 10 – EMPLOYEE DEATH
- 1001 Surviving Spouse and Dependents
- 1002 Surviving Spouse Who Is Also an Employee Eligible for
Coverage
CHAPTER 11 – CODES
- 1101 County Codes
- 1102 Coverage Codes
- 1103 Employee Type Codes
- 1104 Enrollment Type Codes
- 1105 Program Option Codes
- 1106 Standard Plan Waiting Period Codes
- 1107 Surcharge Codes
CHAPTER 12 – AUTOMATED MONTHLY
REPORTING
- 1201 Introduction
- 1202 Install Procedures
- 1203 Reporting to ETF
- 1204 A Few Tips Before Beginning
- 1205 Icons
- 1206 Main Screen
- 1207 Coverage Entry Screen for Active Employees
- 1208 Coverage Entry Screen for Employer-Paid Annuitants
- 1209 Coverage Entry Adjustment Screen for Active and Retired
Employees
- 1210 Entering Payment Information
- 1211 Export
- 1212 Print
- 1213 Report Formatting
- 1214 Roll Forward
- 1215 Back-Up
- 1216 Generation of Paper Copies of Reports
CHAPTER 13 – REFERENCE
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