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Health Insurance It's Your Choice 2022 Information for State Employers - Wisconsin Department of Employee Trust Funds

Employer News September 3, 2021

It’s Your Choice open enrollment is coming up September 27 - October 22, 2021.

The annual health benefits open enrollment period allows uninsured but eligible employees and retirees to enroll for coverage effective the following January 1. This is also an opportunity for currently insured subscribers (active employees, retirees and continuants) to change health plans, enroll or remove adult children from family coverage, change from individual to family coverage, change from family to individual coverage, or cancel coverage.

We encourage employees to electronically submit their enrollment changes. The enrollment process may vary between employers. Employers must verify their enrollment process and communicate instructions to employees. There is targeted enrollment information in the health benefits sections of the ETF web site. 2022 health insurance information will be available at the end of September prior to the open enrollment period. Please see the Employer’s Application Processing Instructions for It’s Your Choice 2022 later in this bulletin for more information.

The 2022 health benefits decision guides will be delivered to all employers at the end of September, if requested. The 2022 health benefits web pages will be available online to employers and members by the end of September. Visit etf.wi.gov for open enrollment information. 

Please consider using the sample email at the end of this employer news to notify employees of open enrollment and important changes. To comply with federal notification requirements, see the Electronic Distribution of the Health Benefits Decision Guides section below. Since these web pages will not be available until the end of September, please do not send this email to your employees until the last week of September.

State Employer It’s Your Choice Kick-off Meeting

2022 Virtual Benefit Webinars

2022 What’s Changing Video

Important Plan and Program Changes

It’s Your Choice HDHP Reminders

Federal Section 1557 Non-Discrimination Information

General It’s Your Choice Information

2022 Health Benefits Decision Guides Distribution

Employee Responsibilities

Additional It’s Your Choice Instructions and Information

Contacting the Health Plans

Sample Employee Emails

State Employer It’s Your Choice Kick-off Meeting

The It's Your Choice 2022 employer kickoff event for plan year 2022 will be held virtually. This kickoff meeting will follow a similar agenda as in previous years, and a recording of this event will later be available on the ETF website for viewing anytime. 

Date: Thursday, September 16, 2021

Time:  9:00 a.m. - 12:00 p.m.  

Registration: September 16 kickoff registration link

The It’s Your Choice kick-off meeting provides an opportunity to receive information from representatives from the health plans, benefit vendors, and ETF employees regarding benefit program changes effective January 1, 2022.

2022 Virtual Benefit Webinars

ETF is hosting a series of webinars for employers and members to connect with health benefits vendors during the  2022 open enrollment period. These webinars with the vendors will provide the same personal interaction with a vendor as a benefit fair or kickoff event from the safety of your own home or office. 

Additional details and registration information will be provided in the near future. Attendees must pre-register to attend these events online via webinar. Due to the high demand, please register as soon as possible.

2022 What’s Changing Video

A video outlining important changes for plan year 2022 is now available. Please share with your employees the last week of September.

Important Plan and Program Changes

Health Plan Changes 

New Health Plan: Aspirus Health Plan will be available for plan year 2022. This new health plan will cover select counties in north-central Wisconsin.

  • Covered counties: Clark, Florence, Forest, Iron, Langlade, Lincoln, Marathon, Oneida, Portage, Price, Shawano, Taylor, Vilas, Waushara, and Wood. 
  • Key provider systems include: Aspirus Health, Ascension North Central, ThedaCare, and Bellin Health. 

Service Area Change: The current Quartz Community network will be discontinued at the end of plan year 2021. It is being replaced by two new network offerings – Quartz Central and Quartz West. 

Current Quartz Community members should select a new health plan during open enrollment. If a new health plan is not selected, current Quartz Community members will be assigned to either the Central or West network, depending on the location of their primary care provider. 

Quartz Central covers select counties in the middle and eastern parts of Wisconsin – outside of Dane County. 

  • Covered counties: Adams, Columbia, Dodge, Fond du Lac, Grant, Green, Green Lake, Iowa, Jefferson, Juneau, Lafayette, Marquette, Richland, Rock, Sauk, Walworth, Waukesha, Waushara, and Wood. 
  • Key provider systems include: Aurora Health System, ProHealth Care, and ThedaCare.

Quartz West covers select counties in western Wisconsin.

  • Covered counties: Buffalo, Chippewa, Clark, Crawford, Eau Claire, Jackson, La Crosse, Monroe, Pepin, Trempealeau, and Vernon. 
  • Key provider systems include: Gundersen Health System, as well as other local and regional providers.  

Note: The Quartz – UW Health network, providing coverage to Dane County, will not be impacted by this network change. Quartz – UW Health members will automatically continue their current enrollment unless they change their elections during open enrollment. 

State Maintenance Plan: The State Maintenance Plan (SMP) is newly available in Florence County. Employees should make sure their providers are in-network or select another plan. 

Benefit Changes

Medical Benefit Changes: There are several minor medical benefit changes for plan year 2022, including:

  • Adding coverage for medically necessary corrective jaw surgeries, 
  • Removing the timeframe requirement for tooth extractions or dental repairs due to accidents, and 
  • Updating and specifying telemedicine coverage

The updates and specifications to telemedicine coverage for plan year 2022 include new service category definitions and cost-sharing. These new categories better reflect health plan coding classifications and are intended to improve the member experience, especially as telemedicine options continue to be used more frequently. 

Visit the ETF website for more details about telemedicine coverage, including service category definitions and cost-sharing details. 

Limit Changes: Several limit changes were also approved for plan year 2022, including:

  • Updating the medical maximum out-of-pocket limit to match the annual federal maximum, 
  • Applying all medical benefits to the maximum out-of-pocket limit, and 
  • Removing Level 4 pharmacy benefit out-of-pocket limit for commercial members. 

Continuous Glucose Monitors: Continuous Glucose Monitors, or CGMs, will be covered under the pharmacy benefit during plan year 2022 for commercial members.  

CGMs are wearable devices for diabetes management. They are currently covered under the medical benefit – and will be available under both the medical and pharmacy benefit in 2022. 

Members will only receive a CGM under one of the benefits. CGM model availability varies between health plans and the pharmacy benefit. 

Dental

New Uniform Dental Benefit: Coverage for composite resin fillings for back teeth has been added to the uniform dental benefit effective January 1, 2022. Composite resin fillings are also known as white fillings. 

The uniform dental benefit already covers composite resin fillings for front teeth. Soon, both your front and back teeth will be able to benefit from these natural looking fillings. 

The uniform dental benefit and all supplemental dental benefits will continue to be administered by Delta Dental. 

Dental Rate Changes: Delta Dental of Wisconsin will continue to provide the Preventive Plan, Select, and Select Plus Supplemental Dental Plans in 2022.

Dental rates are changing effective January 1, 2022. Of note, there has been a reduction to the monthly premium amount for Uniform Dental individual coverage. 

  • Individual: $3 per month ($1 reduction from 2021)
  • Family: $9 per month (no change from 2021)

Active Employee 2022 Monthly Dental Rates

  Uniform Dental Benefit Preventive Plan Select Plan Select Plus Plan Individual $3 $34.72 $9.76 $20.98 Individual + Spouse n/a n/a $19.52 $41.96 Individual + Child(ren) n/a n/a $13.16 $38.96 Family $9 $86.80 $23.40 $64.28

Supplemental Benefit Plans

Accident Plan by Securian Financial: Employees of UW Hospitals and Clinics are eligible to enroll in the Accident Plan for coverage beginning January 1, 2022.  There are two notable changes to the Accident Plan for plan year 2022:

  • Most claim payment amounts will increase. This means members will receive a greater cash payment amount to help cover accident-related expenses than in prior plan years – at the same monthly rate. 
  • Physical therapy visits have been added as a covered claim type for 2022. Physical therapy visits will need to be related to a covered accident type to receive payout. 

Disclaimer: UW System and UW Hospital and Clinics employees may have different supplemental benefits.

Vision Plan by DeltaVision: DeltaVision, with EyeMed Vision Care, will continue to provide supplemental vision coverage in 2022. 

Group Health Insurance Opt-Out Option

Employees who wish to claim the $2,000 opt-out incentive must complete the Health Insurance Application/Change (ET-2301) form (complete Sections 1, 12 and 13) unless the employer has an ETF approved electronic system to gather and report this information (for example, STAR). Employees must complete this opt-out request each year.

Pre-Tax Savings Accounts 

Vendor Name Change: Optum Financial has replaced the ConnectYourCare name and brand throughout the member experience. 

  • Customer service offerings will remain the same. 
  • Payment cards will not be reissued – members should continue to use the same card until it expires. 
  • Continue to use connectyourcare.com/etf to view resources and access the member portal for the time being. 

New Eligible Expenses: Eligible expenses for the HSA and Health Care Flexible Spending Account (FSA) now include Personal Protective Equipment, or PPE, for the primary purpose of preventing the spread of COVID-19. Eligible PPE includes face masks, disposable gloves, hand sanitizer, and sanitizing wipes. 

This change is retroactive to January 1, 2021, so members with current HSA or FSA accounts can already submit PPE purchases made during plan year 2021 for reimbursement. 

A searchable list of all eligible expenses is available on the Optum Financial website. 

Pre-Tax Savings Account Limit Changes: The IRS has not yet released FSA maximums and limits applicable for 2022. Limits for 2022 are expected to be released after the start of open enrollment. ETF will review the maximums and limits for 2022 when the information becomes available. In the event of significant changes, ETF may choose to alter the current annual contribution limits for 2022. 

  • HSA Employee Contribution Limits: The 2022 annual individual limit for an HSA contribution will increase by $50 (from $3,600 to $3,650). The annual family contribution limit will increase by $100 (from $7,200 to $7,300).
  • HSA Employer Contributions: Employer contributions for the HSA for 2022 remain $750 per individual coverage and $1,500 per family coverage. Employer contributions must be made in accordance with instructions provided by the Department of Administration’s Division of Personnel Management (DPM).

It’s Your Choice HDHP Reminders

To be eligible to enroll in the High Deductible Health Plan (HDHP) or Access HDHP, the subscribing employee must be enrolled in the Health Savings Account (HSA). In addition, the subscriber cannot:

  • Have any other health coverage that pays for out-of-pocket health care expenses before they meet their plan deductible, including Medicare A and B.
  • Be covered by TRICARE.
  • Be claimed as a dependent on another person’s tax return (unless it’s their spouse).
  • Have a Health Care Flexible Spending Account (FSA) in the same year (also applies to spouse). Some health care FSAs can be converted; the subscriber should contact the administrator of their Health Care FSA for more information.

Note: If a subscriber has Veterans Administration (VA) benefits, this is not disqualifying health care coverage. The subscriber may only utilize VA benefits for care of a service-related disability. If the subscriber does not have a service-related disability, they are unable to contribute to an HSA if they have accessed their Veterans Administration (VA) benefits in the 90 days prior to open enrollment or if they access VA benefits during their enrollment in HDHP/HSA benefit option. (It is the subscriber’s responsibility to know when they can and cannot contribute. If the subscriber has questions, they should speak with their tax consultant.)

If the employee/subscriber meets all eligibility criteria and does not have any disqualifying health care coverage, but the spouse and/or dependent(s) have other health insurance coverage (such as non-HDHP health insurance, Medicare, Medicaid or TRICARE), the subscriber and their spouse and/or dependent(s) are eligible for the family HDHP/HSA. The subscriber can contribute up to the HSA family maximum amount and the $1,000 catch-up, if applicable. HSA funds can be used for the spouse’s and/or eligible tax dependent’s eligible medical expenses if the same expenses are not being reimbursed in another way.

Reminder: An HSA application must be accepted, not just submitted, to be eligible for an HDHP.

Well Wisconsin Program

The deadline to earn the 2021 Well Wisconsin incentive is October 8, 2021. Participants will receive the $150 gift card sent by postal mail to their home address. Two new Well Wisconsin web resources are available on the ETF website:

  • Well Wisconsin for Members
  • Well Wisconsin for Employers 

Federal Section 1557 Non-Discrimination Information

Reminder: Please notify ETF of requests for health benefit information to be translated into languages other than English. Please share data about which information is being requested and in what language. Send to [email protected]

General It’s Your Choice Information

To change health plans or coverage levels or opt-out of medical or decline dental coverage, employees must submit a completed electronic or paper health insurance application to their employers no later than Friday, October 22, 2021.

Employees may select any health plan regardless of their county of residence, but should consider whether the providers are within a reasonable distance for medical care. The 2022 Health Plan Search page will identify counties covered by each health plan, as well as a listing of their major providers and links to provider directories.

The updated Group Health Insurance Application/Change (ET-2301) form can be downloaded from ETF’s Internet site or you may order applications by completing the Online Forms Order page found on the employer forms page on the ETF website.

Retirees Continuants: ETF mails decision guides directly to retirees and former employees who have continued their health insurance coverage. These mailed guides will have the Health Insurance Application/Change for Retirees and COBRA Continuants (ET-2331) enclosed. Employees who wish to change health plans and who will retire effective January 1, 2022 or later, must complete their It’s Your Choice applications as active employees. Employees who will retire prior to January 1, 2022 should submit their It’s Your Choice application to ETF. Changes for retiree and continuant coverage are handled by ETF.

2022 Health Benefits Decision Guides Distribution

The 2022 health benefits decision guides must be distributed in a timely manner to all employees. The distribution method (hard copy, link to web version, PDF file) is determined by the employer. It is acceptable for employers to distribute health benefits decision guides using an electronic method during the COVID-19 outbreak. Employee distribution should include: 

  • Employees who have indicated they do not wish to make a change during the It’s Your Choice open enrollment period.
    • Remind these employees that they remain responsible for understanding the information contained in the guides and the ETF website, and that their certificate of coverage is available on the ETF website. We encourage you to point employees to the enrollment checklist on the inside cover of the Health Benefits Decision Guide for important reminders.
  • Insured employees on temporary layoff or leave of absence and those on permanent layoff paying premiums through the employer.
  • Employees who allowed health insurance coverage to lapse while on a leave of absence or a temporary layoff that encompassed the entire open enrollment period should be advised they are eligible to make a health benefits election within 30 days of returning from the leave or layoff.

Electronic Distribution of the 2022 Health Benefits Decision Guides

Employers distributing open enrollment information electronically must incorporate the following as part of their electronic distribution procedures:

  • Develop a list of all eligible employees and use that list to match against their file of employee email addresses.
  • Verify the list and then send the employee an email (see sample email below) with the link to the guides and online information. Employers should send the email with a “return receipt.” This will establish a record of when the employee opened the email.
  • Due to federal regulations, employers must retain the list of employees who received an electronic copy of the IYC materials. For each employee who is sent an email message, the employer should receive a “reject” notice if the email address is no longer in existence.

Note: While ETF generally recommends that you give new employees paper copies of the guides, distributing links to web versions or PDF files of the health benefits decision guides during the COVID-19 outbreak is acceptable. However, if employees who do not have access to a computer and/or employees who receive the electronic distribution but request a paper copy, must be given one.

Employee Responsibilities

Employees must contact health plans directly to request the most up-to-date information regarding service area and/or provider availability related to open enrollment.

Note: When contacting a health plan or Navitus, employees must identify themselves as a State of Wisconsin Group Health Insurance Program subscriber in order to receive information pertinent to the program administered by ETF.

Health plans often report they are unable to contact current subscribers due to incorrect addresses on file. Please remind employees who participate in the group health insurance program that they are responsible for providing address changes and revisions of other relevant information, such as marital status changes, to you via a myETF Benefits update or the Group Health Insurance Application/Change (ET-2301) form.

Employers are responsible for keying changes submitted on paper by using the myETF Benefits system found in the Online Tools section of the ETF website or by electronic file transmission if the employer uses this method. Once mailing addresses are updated, employees will receive provider information in a timely fashion, including information for the annual disabled dependent verification process, which enables members whose dependents remain eligible in 2022 to continue their current health insurance. If an employer uses electronic file transmission, employee address updates must be sent separate from the annual open enrollment election or manually keyed by the employer into the myETF Benefits System.

Employer’s Application Processing Instructions for It’s Your Choice

During the open enrollment period, employees should be directed to self-service enrollment options whenever possible. Employers should direct employees to the appropriate payroll center for directions on how to process any application materials.

Employers must either provide their own electronic method of enrollment to transmit to ETF, allow their employees to enroll online or accept paper applications and enter them into myETF on behalf of the employee.

Employers that accept a paper copy of the Group Health Insurance Application/Change (ET-2301) form must collect the applications no later than the close of business on October 22, 2021. If an employer accepts a paper application, the employer must enter that application into the myETF Benefits system on behalf of their employee through the Online Tools link to the myETF Benefits System found on the ETF website. The application is not to be mailed or faxed to ETF for processing and keying. The deadline for employers to enter It’s Your Choice applications into the myETF Benefits system is November 12, 2021.

If the employee submits a paper application to their employer, ETF does not require that a copy of the application be submitted to ETF. Employers are not to make entries on behalf of their employee without an application as documentation of the employee’s request. The employer is to maintain a copy of the paper application in the employee’s file.

If employers are going to accept a Group Health Insurance Application/Change (ET-2301) form, the following steps in processing the application are required:

  • Verify the employee completed the application in its entirety, including signing the application. The application should be promptly returned to the employee if it is incomplete. The application may be signed electronically, as long as the employer can verify the signature. A secure email from the employee stating their intent to apply for health insurance or change their coverage along with a complete health insurance application provided to ETF in the normal manner is acceptable in lieu of a signature.
  • Complete the employer section of the application in its entirety. Do not leave requested information blank.
  • Return a completed copy of the application to the employee. Do not send a copy of the application to ETF or the health plan.

All applications received by the employer on or prior to October 22, 2021 must be entered electronically by November 12, 2021. This deadline must be met by the employer to ensure health plans and Navitus receive the contract information timely so employees receive their health plan information and identification cards prior to January 1, 2022.

Withdrawing/Rescinding an It’s Your Choice Application

Entry into myETF Benefits of an employee’s request to withdraw or rescind a health benefits application must be completed by ETF. Employees may rescind a 2022 application by notifying their employers in writing prior to December 31, 2021. The written request should be filed with the employee’s records. Forward one copy of the employee’s written request to rescind to ETF. An employee may also rescind their request by writing “Rescind” across the top of their original application and initialing.  Forward a copy of this updated application to ETF for processing and keep a copy for the employee’s file. If the employee enrolled through an employer’s human resources benefit application, a copy of the enrollment screen must be submitted, with “Rescind” across the top and initialed by the employee. Retain a copy for your employee’s records. ETF will update myETF Benefits by deleting the request and reinstating the employee’s original coverage.

If an employee submitted his/her request through the myETF Benefits system and now wants to rescind that request, the employee must submit a written request to their employer by December 31, 2021. Employers are to make a copy of that written request and forward it to ETF while retaining a copy for your employee’s records. ETF will update myETF Benefits by deleting the request and reinstating the employee’s original coverage.

Additional It’s Your Choice Instructions and Information

Specific instructions are found in the State Agency Health Insurance Standards, Guidelines and Administration Employer Manual (ET-1118):

  • Information if you have an employee initially eligible for coverage in November or December.
  • Instructions on completing the Continuation - Conversion Notice (ET-2311) if you have an employee who terminates employment in November or December after filing a health benefits application.
  • Information on the process to follow if you receive a late application (an application received after the last day of open enrollment period). ETF reviews all late requests. Note that documents for late applications can be faxed to 1-608-266-5801, attention Employer Services.

Contact the Employer Communication Center at 1-877-533-5020 with questions or email [email protected]

Contacting the Health Plans

The updated Health Plan Contact List (ET-1728) is meant for employers to use when contacting the health plans for assistance with membership, supplies, etc. The contact list includes email addresses and fax numbers when available.

Note that employees who need assistance should contact the health plan directly, using the health plan contact information for members that will be available on the updated health plan pages soon and in the decision guides. These are customer service lines and are fully staffed to handle a large number of phone calls. Employees should specify they are enrolled in the State of Wisconsin Group Health Insurance Program when calling the health plans.

Sample Employee Email

You can use the below sample email to provide It’s Your Choice health benefits information to your employees:

Important Information about Your Health Benefits for 2022 The It's Your Choice open enrollment period, which begins on September 27 and ends on October 22, 2021, is right around the corner.

This is your chance to:

  • Enroll or make changes to your health insurance
  • Add or decline Uniform Dental
  • Enroll in or make changes to supplemental coverage such as dental or vision insurance
  • Enroll in a pre-tax savings account to save money on health care or dependent day care expenses

Changes you make during open enrollment become effective January 1, 2022.

Your To-Do List:

Visit etf.wi.gov for information about your 2022 benefits.

  • Attend a health benefit webinar. ETF will host a number of webinars during the open enrollment period for you to learn about the 2022 plan year. You’ll have the opportunity to ask questions directly to health plans and vendors. Visit etf.wi.gov/health to register. 
  • Use Benefits Mentor, the new interactive benefits counselor for active state employees and non-Medicare retirees. Powered by ETF’s secure data warehouse, Benefits Mentor will use your claims information (if available) as a basis for personalized plan design recommendations. Benefits Mentor also considers your medical needs and what is most important to you when choosing a health plan. 
  • Watch the 2022 Open Enrollment Preview video to learn about changes that may impact you in the upcoming plan year.
  • The deadline to submit your electronic request or your completed paper application to your benefits office is 4:30 p.m. on October 22, 2021. (Employer, replace this bullet with information about your electronic enrollment system, and/or alter the deadline time if your office is open later.)

Language assistance is available.