UNIVERSITY OF WISCONSIN River Falls

Health and Other Insurance

When can I enroll in Health Insurance?

If you are faculty, visiting faculty, academic staff (unclassified positions) or if you fall into the graduate assistants/short-term employee category you must submit an application to your staff benefits specialist no later than 30 calendar days from the contractual begin date of your appointment. The university pays most of your health insurance premium.

Classified Employees

If you are a classified employee, you generally have two opportunities for enrollment in the State Group Health Insurance Program. The university does not pay the employer contribution towards the premium during the first two months of WRS covered employment (six months for LTEs). After two months (six months for LTEs), the university pays most of your health insurance premium.

  1. If you want health coverage as soon as possible, you must submit an application to your staff benefits specialist no later than 30 calendar days from the begin date of your appointment. You will pay the total premium for the first two months of coverage (six months for LTEs).
  2. If you want health coverage when the University first contributes towards the premium, you must submit your application on or before the first of the month following the month in which you complete your first two months as a state employee in the Wisconsin Retirement System (six months for an LTE).

If you are transferring from another UW System institution or state agency or if you are a new employee with at least two months of prior Wisconsin Retirement System service with a state agency, you must submit an application to your staff benefits specialist no later than 30 calendar days from the contractual begin date of your initial appointment with the university or your coverage may lapse.

Regardless of when you want your health coverage to be effective, you are strongly encouraged to submit a completed application as soon as possible to avoid missing your initial enrollment period.

What happens if I did not sign up during my enrollment opportunity? http://www.uwsa.edu/hr/benefits/newemp/deadline.htm
link
Employees not currently participating in the State Group Health Insurance program are eligible to apply for coverage during the annual benefits enrollment period held each October.  Enrolling during this time will establish coverage effective January first of the following year.

If you are covered under the State Group Health Insurance program in effect by October 1 of any year, you will be allowed to change to a different health plan effective January 1 of the following year by submitting an application during the Annual Benefits Enrollment period in the fall.

What happens if I had other health insurance, but lost it?
If you and/or your dependent(s) are not insured under the State Group Health Insurance program because of being insured under a comparable group health insurance plan elsewhere, and you lose eligibility for that coverage or the employer terminates its premium contributions, you may take advantage of a special 30-day enrollment period to become insured in the State Group Health Insurance Program without waiting periods for pre-existing conditions, if you are otherwise eligible.

This enrollment opportunity is also available to employees and/or dependents who lose medical coverage under medical assistance (Medicaid), as a dependent of a member of the U.S. Armed Forces, or as a citizen of a country with national health care coverage comparable to the Standard Plan.

The enrollment period begins on the date the other group health insurance coverage terminates because of loss of eligibility (e.g., termination of employment, divorce, loss of employer contribution, etc., but not voluntary cancellation of coverage). If you are currently enrolled and need to change from single to family coverage, all eligible family members must have lost the other coverage in order to qualify.

To enroll, submit a health insurance application form and other information documenting the loss of coverage to your staff benefits office within 30 days of the date the other coverage ended. The effective date of coverage will be the day after the termination date of the other coverage.

Are there any other special enrollment opportunities?
HIPAAlink (Health Insurance Portability and Accountability Act) allows a special enrollment when an employee or dependent is eligible but not enrolled and there is a marriage, birth, adoption, or placement for adoption, if coverage is elected within 30 days of the event. Coverage is effective on the date of birth, adoption or placement for adoption, or marriage. This special enrollment also allows you to change health plans within 30 days of the event.

If you are covered when a qualifying event occurs, you can also elect to change health plans within 30 days of the event. Should you or a covered dependent ever reach the health plan's lifetime maximum benefit, you may also elect to change plan within the required time frame.

If you do not enroll during these special enrollment opportunities, your next opportunity to enroll will be during the Annual Benefits Enrollment period.

It's Your Choice

http://etf.wi.gov/members/health_ins.htmlink

The It's Your Choice Enrollment period is offered only to subscribers presently insured under the State Group Health Insurance program.  It's Your Choice is an “open enrollment” period for Health Insurance.

At the ETF Group Health Insurance Program web pagelink , you can link to the 2013 It's Your Choicelink book for State Employees, which is in pdf format for easy searching. The It's Your Choice book includes the following sections:

  • Important Considerations when selecting a health plan
  • Section A:  Premium Rate Information
  • Section B:  State and Federal Notifications/Patients' Rights and Responsibilities
  • Section C:  Common Questions and Answers
  • Section D:  Uniform Benefits, which apply to all participating health plans except the Standard Plan
  • Section E:  Health Plan Report Cards
  • Section F:  Where to Get More Information
  • Section G:  Plan Descriptions.  Include plan-specific information such as dental benefits, service area and major provider information

Other information that is available at the ETF Group Health Insurance Program website includes:

Can I Rescind My Dual Choice Election?
You may submit or change an application at any time during the Dual-Choice period. After that time, you may withdraw your application (and keep your current coverage) by notifying your benefits/payroll office in writing before December 31.

Common Questions-Section C Dual Choice
http://etf.wi.gov/members/health_ins.htmlink

Dependent Children

When does coverage for dependent children terminate?

Coverage for dependent children who are not physically or mentally disabled terminates on the earliest of the following dates:

  • The end of the month in which the child marries.
  • The end of the calendar year in which the child:
    1. Turns 26 while not a full-time student.
    2. Turns 26 while still a full-time student.
    3. For a stepchild, the end of the month in which your divorce from the child's parent is entered.

The date eligibility for coverage ends either for the dependent or the subscriber. For information about your dependents' right to continue coverage, you may want to view this PowerPoint presentationdocumentlink .

Under no circumstances may other relatives (e.g., parents, grandparents) be covered under a family contract.

I have a bill from the Insurance Company?
My Health Insurance is not paying bills?

Contact your insurance provider, most services will be subject to co-insurance rates. 

How does the prescription drug benefit work?
Pharmacy and prescription benefits are administered by Navitus Health Solutions, a third-party pharmacy benefit manager (PBM). No matter which health plan is selected, all employees have prescription coverage through Navitus, not the individual health plan.

Participants will receive a separate identification (ID) card from Navitus, in addition to the ID card they receive from their health plan. The Navitus card must be shown at the time prescription drugs are purchased.

The following shows the member's cost under the three-level copayment structure for pharmacy benefits:

  • Level 1 Copayment for each formulary prescription drug = $5.00 (for preferred generic and certain low cost brand name drugs).
  • Level 2 Copayment for each formulary prescription drug = $15.00 (for preferred brand name and certain higher cost generic drugs).
  • Level 3 Copayment for each non-formulary prescription drug = $35.00

There is an annual out-of-pocket maximum that applies to Level 1 and Level 2 prescription drugs and insulin. For employees covered by an HMO or the State Maintenance Plan, the 2009 out-of-pocket maximum is $385 per individual or $770 per family. If enrolled in the Standard Plan, the out-of-pocket maximum is $1,000 per individual and $2,000 per family. After the out-of-pocket maximum is reached, Level 1 and 2 drugs are covered in full for the remainder of the year.

Important Note: Level 3 prescription co-payments do no apply to the out-of-pocket maximum and must continue to be paid after the annual out-of-pocket maximum has been met.

Navitus offers mail-order prescriptions at a reduced cost (3-month supply for 2 copayments) and also has other cost-saving features available such as pill-splitting and generic sampling.

For more information, such as what a formulary is, how it is established, and which level of copayment applies to specific prescriptions, visit www.navitushealth.comlink or call Navitus toll-free at 1-866-333-2757.

ERA

Employee Reimbursement Account

How do I submit a claim to ERA/WageWorks?
http://etf.wi.gov/publications/era_reimburse.pdfdocumentlink

Is there a “grace period” for submitting claims?
Yes. A 2-1/2 month grace period following the end of the Plan year applies to both the Medical Expense and Dependent Care accounts. Effective with the 2006 Plan year, dependent care expenses as well as medical expenses for services provided through March 15 of the current year may be reimbursed with funds remaining from the previous plan year. However, any unused amounts from the prior plan year that are not used for expenses incurred by March 15 remain subject to the “use it or lose it” rule and will be forfeited. The deadline (or run-out period) for filing both medical expense and dependent care claims incurred during the Plan year, including the grace period, is April 15.

What if I haven't used all the money I set aside?
Any unused money is forfeited (please see “ grace period ” question for further explanation.

Can I change my ERA deductions?
Any request to change must be made directly to WageWorks using the following form:
http://etf.wi.gov/publications/era_status_chg.pdfdocumentlink

Summer Prepay Deductions/Leaves
Summer prepay insurance deductions are taken from your March, April and May payroll check if you hold one of the following unclassified appointments and are not terminating in June, July or August:

  • Faculty or academic staff academic (nine-month) appointment.
  • Project or program assistant with an appointment end date in May. (Reduced or school session only employees)
  • Your department will determine if you are eligible for Summer prepay insurance deductions.

Why Multiple Deductions?
Multiple insurance deductions are taken from the March, April and May payroll checks to ensure that your insurance coverage is continuous during the summer. Insurance premium deductions are not taken from summer session payroll. Insurance premium deductions resume with the October 1 payroll check.

How is the Number of deductions determined?
Three additional deductions will be taken for each insurance program, one each for June, July and August unless you retire or terminate in June, July or August.

What about multiple deductions for TSA , DC or ERA?
Multiple deductions are not taken for tax-sheltered annuities, Deferred Compensation or Employee Reimbursement Accounts. You should consider this when enrolling in these programs. Deductions for these programs will resume with the October 1 check. The Salary Reduction Agreement form is available on the University of Wisconsin System Administration (UWSA)documentlink websitedocumentlink .   Contact Deferred Compensationlink to make changes to your DC account.

How do you continue benefits if terminating employment in the summer?
Advise your department benefits coordinator of your termination date as soon you know it. Request continuation/conversion information and application forms for all benefit plans that you want to continue. Application deadlines apply to each plan, so request and complete these forms in a timely manner. Our website has more information about benefits upon terminationlink .

Make an appointment with the Benefits Specialist at 715.425.3109 prior to the end of the semester. Our benefits specialist can counsel you about continuation/conversion of your benefits and coordinate conversion of sick leave for continuation of your State Group Health Insurance through the Department of Employee Trust Funds.

What if I have a family-status change in the summer?
Notify your department benefits coordinator immediately if a family status changes (i.e. marriage, divorce, birth, etc.) occurs during the summer as most plans have a 30-day deadline for submitting changes. Family status changes can affect a number of benefit plans (i.e. single-to-family, or family-to-single coverage for health insurance, a change to ERA deductions, beneficiary designation changes, etc).

I'm going to be off work, how do I pay for my insurance(s)?
Leave Without Pay
Most premiums can be prepaid via payroll deduction for a specific number of months. To qualify for this you must notify your benefits specialist as soon as you are anticipating time off without pay. If the payment via payroll deduction is not possible, you will be receiving a monthly invoice from our office. You will be responsible for returning each invoice with payment by the date indicated on the invoice or your coverage will lapse. Please contact your benefits specialist for more information.

Leave With Pay
If you are taking a paid leave, your deductions will continue as they did while you were present at work. Please contact your payroll and/or benefits specialist to discuss specifics and leave usage.

UIA

University Insurance Association (Faculty)

What is UIA? Why is it mandatory? When do premiums come out?

  • UIA is University Insurance Association, is a mandatory life insurance for
  • Premiums are deducted one time each year in October.
  • New employees who were not paid in October will have one half of the premium deducted in the spring.

Durable Medical
Page D-27 of the It's Your Choice booklet:
http://etf.wi.gov/members/health_ins.htmlink

When prescribed by a Plan Provider for treatment of a diagnosed Illness or Injury and purchased from a Plan Provider, medical supplies and Durable Medical Equipment will be covered subject to 20% Coinsurance as outlined in the Schedule of Benefits. All purchases or monthly rental must be Prior Authorized as determined by the Health Plan. Check the booklet for a listing of covered supplies and equipment.

TMJ- Treatment of:
As required by Wis. Stat. 632.295 (11), coverage is provided for diagnostic procedure and Prior Authorized Medically Necessary surgical or non-surgical treatment ofr the correction of temporomandibular disorders. Please see paged-23 of the It's Your Choice booklet: http://etf.wi.gov/members/health_ins.htmlink

Ombudsperson Services:
http://etf.wi.gov/members/ombudsperson.htmlink

Benefit Orientation
http://www.uwsa.edu/hr/benefits/newemp/orientwrs.pdfdocumentlink

New Employees
http://www.uwsa.edu/hr/benefits/newemp/link

Life Events (Status Change)
http://www.uwsa.edu/hr/benefits/lifevent/link

Domestic Partner
The domestic partner of a UW System employee may be eligible for certain benefits. To be eligible for benefits as a domestic partner, the employee and his/her partner must be in an established domestic partnership of at least six months and meet the criteria set forth in the Domestic Partner Affidavit (UWS-50). A domestic partner may be of the same or opposite sex. An employee can enroll a domestic partner for any applicable insurance benefits only within specified eligibility periods – when the employee is newly hired and enrolls in benefits for the first time, during an open enrollment period or within 30 days of satisfying the requirements of an eligible domestic partnership set forth in the Affidavit of Domestic Partnership. For more information: http://wwwnew.uwsa.edu/hr/benefits/dpsummary.pdfdocumentlink

EyeMed
For routine eye exams, Humana requires that you use an EyeMed provider. Please see Humana's website site for a list of providers. www.humana.comlink

What is the value of my estimated total compensation?
http://www.uwsa.edu/hr/benefits/compest/link

What is the value of my fringe benefit:
http://www.uwsa.edu/fadmin/fringes.htmlink

Where do I find information on ETF?
http://etf.wi.gov/members.htmlink

How do I contact ETF?
http://etf.wi.gov/contact.htmlink