BN - Enrollment Code and Enrollment Reason Job Aid

GENERAL DESCRIPTION:

Enrollment Codes and Enrollment Reasons are used to drive electronic reporting of State Group Health (SGH), Dental, VSP, life insurances, and ICI benefits. The table below shows Enrollment Codes with their corresponding Enrollment Reasons as well as when they will typically be used.

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ENROLLMENT CODES AND REASONS

ADD COVERAGE

Enrollment Reason Enrollment Description \ When to Use Required Forms Received Forms Within ADM Event NOTES
New Hire Employee is new and adding coverage 'when employer contributes to premium' Self Service or benefit applications 30 days Health plans - First of the month following Hire Date

Life plans - First of the month following 30 days
New Employees Resource

Enrollment Deadline Worksheet
New Hire – Coverage Start ASAP Enrollment Reason is not in use



Birth Employee is adding coverage for the first time due to a birth benefit applications
SGH: Notarized Maternity Acknowledgement, if employee adding child is single and female
60 days from Date of Birth Health plans - Date of Birth

Life plans - First of month on or following 30 days from date of birth
Date of Birth
Birth Resources
Adoption/Placement of Adoption Employee is adding coverage for the first time due to an adoption 1. benefit applications
SGH: Recorded copy of court order granting adoption or letter of placement for adoption
60 days from date of adoptionHealth plans - Event Date

Life plans - First of month on or following 30 days from date of adoption
Date of Adoption
Adoption Resources
Nat'l Medical Support Notice Employee is adding coverage for the first time due to a court-ordered National Medical Support Notice Only used for Health plans
1. benefit applications
2. National Medical Support Notice
30 days of the court ordered noticeCoverage is effective first of the month on or after receipt of application or the date specified on the NMSN, if one is specified.NMSN Resource
Marriage Employee is adding coverage for the first time due to their marriage benefit applications30 days of marriageHealth plans - Date of Marriage

Life plans - First of month on or following 30 days from date of marriage
For SGH: If two state employees with single coverage, first of the month following date of marriage.
Marriage Resource
Domestic Partnership Enrollment Reason is not in use



Change Subscriber (Sp to Sp) Both employees work for State of Wisconsin and the employee is transferring subscriber status from their spouse to themselves for their existing health plan. Only applicable with a life event and can only be used for health plans. benefit applications30 days of the event that allows the changeFirst of the month following app received date

Return from Unpaid LOA Employee is returning from unpaid leave of absence and is re-enrolling due to a lapse in coverage. benefit applications30 daysFirst of the month following return to work date
LOA Resource
Loss of Other Coverage/ER Cont Employee is adding coverage for the first time due to their loss (or dependent’s loss) of other health coverage (or of employer’s share). Only used for health plans. 1. benefit applications
2. COBRA / Certificate of Credible Insurance
3. Letter from Previous Employer stating why coverage was lost
30 days from the Loss of CoverageFirst day following Loss of Coverage
Return from FMLA Leave Employee is returning from unpaid FMLA leave and is re-enrolling due to a lapse in coverage. benefit applications30 daysFirst of the month following return to work date
LOA Resource
Return from Military Leave Employee is returning from a Military leave and is re-enrolling due to a lapse in coverage. benefit applications30 daysFirst of the month following return to work date
LOA Resource
1 Month Before Retirement Employee is adding coverage 1 month in advance of retirement. Employee is limited to the Standard Plan. Only used for SGH plans. ETF Health Insurance ApplicationEnd of the month of terminationFirst of the month of retirement
Reinstatement Employee is rehired within 30 days from termination from any State of Wisconsin employment.  There is no break in the insurance coverage. No application requiredIf reinstatement is retroactive more than 90 days, create a ticket for UWSC
First of the month the coverage needs to continue (If termination row has been entered)
Paternity Acknowledgement Employee is adding coverage for the first time due to a Paternity Acknowledgement 1. ETF Health Insurance Application
2. Notarized Paternity Acknowledgement
60 days of Paternity AcknowledgementIf received within 60 days of birth, Date of Birth is effective date.

If received beyond 60 days of birth, coverage is effective the first of the month on or after receipt of application.
Paternity Resources
Transfer from Other Agency Employee is transferring to UW. Employee may not change existing benefits but may add enrollments for newly eligible insurances benefit applications30 daysFirst of the month following Hire Date (verify coverage on Personnel Transfer Record)
Change Employee Type Employee is moving from regular to University Staff Temporary (LTE), or University Staff to FA/AS/LI, or vice versa. ETF Health Insurance Application30 daysFirst of the month following Job Data - Benefit Program Participation DateEmployment Changes
It's Your Choice Enrollment Enrollment Reason is not in use




CANCEL COVERAGE

Enrollment Reason Enrollment Description \ When to Use Required Forms Received Forms Within ADM Event NOTES
Post-Tax Deductions Employee is cancelling coverage and their deductions are taken post-tax.  Employees with post-tax deductions can cancel mid-year for any reason. Also used for employees voluntary cancelling life plans or ICI.
benefit applications any timeFirst of the month following receipt of application
Unpaid Leave of Absence (Lapse) For Service Center use only; employee's coverage cancels due to LOA (lapse of coverage) No application required30 daysFirst of the month on or after notified by employeeLOA Checklist
Less than Half-Time Employment Employee cancels coverage due to going part-time and being charged the less than half-time premium rate ETF Health Insurance Application30 daysFirst of the month following receipt of application
Premium Increase When the employer share of the premium contribution decreases by at least 5% and the employee share increases, this is considered a significant increase in the employee premium contribution. ETF Health Insurance Application30 daysFirst of the month following receipt of application
Eligible for Other Coverage Employee is eligible for other coverage 1. benefit applications
2. Copy of Proof of Other Health Coverage
30 daysFirst of the month following receipt of application
It's Your Choice Enrollment Enrollment Reason is not in use



Termination of Employment Employee's coverage cancel upon termination No application required
N/A system will automatically terminate benefits with a TER Event
Retirement Employee's coverage cancel upon retirement No application required
N/A system will automatically terminate benefits with a RET Event
Death of Subscriber Employee's coverage cancels due to death No application required30 daysFirst of the month following date of death
Disability Approval (Non_ICI) Enrollment Reason is not in use



Benefits Billing Non-Payment For Service Center use only; employee's coverage cancels due to non-payment No application required
First of the month following last paid through date

ADD DEPENDENT

Enrollment Reason Enrollment Description \ When to Use Required Forms Received Forms Within ADM Event NOTES
Nat'l Medical Support Notice Employee is adding a dependent to their coverage due to receipt of a National Medical Support Notice. This is when a court orders the parent in question to provide coverage. For their child(ren). Only used for health plans. 1. benefit applications
2. National Medical Support Notice
30 daysCoverage is effective first of the month on or after receipt of application or the date specified on the NMSN, if one is specified.NMSN Resource
Legal Ward Employee is adding a dependent to their coverage due to legal ward/legal guardianship.  1. benefit applications
2. court order granting legal guardianship
Health plans - 60 days of date of legal guardianship granted

Life plans - First of month on or following 30 days from date legal guardianship is granted.
Date of Legal Guardianship Legal Guardianship Resources
Paternity Acknowledgement Employee is adding a dependent to their coverage due a Paternity Acknowledgement 1. benefit applications
2. Notarized Paternity Acknowledgement
60 days of Paternity AcknowledgementIf received within 60 days of birth, Date of Birth is effective date.

If received beyond 60 days of birth, coverage is effective the first of the month on or after receipt of application.
WHDS Paternity Resources

Birth Resources
It’s Your Choice Enrollment Enrollment Reason is not in use


 
Birth Employee is adding a dependent to their coverage due to the dependent’s birth benefit applications
SGH: Notarized Maternity Acknowledgement, if employee adding child is single and female
60 days from Date of BirthHealth plans - Date of Birth

Life plans - First of month on or following 30 days from date of birth
Birth Resources
Loss of Other Coverage Employee is adding a dependent to their coverage due to the dependent’s loss of other coverage. Only used for health plans. 1. benefit applications
2. COBRA / Certificate of Credible Insurance
3. Letter from Previous Employer stating why coverage was lost
30 days from the Loss of CoverageFirst day following Loss of Coverage
Not On Initial Enrollment Employee is adding a dependent younger than 19 to their coverage due to omission on the initial enrollment. Only used for SGH plans. ETF Health Insurance ApplicationNo limitation [coverage begins prospectively]First of the month on or after receipt of application
Disabled Dependent Over Age 26 Employee is adding a dependent to their coverage as a disabled dependent over the age of 26. Only used for health plans. 1. benefit applications
2. Disability documentation
No limitationDate disabled dependent is approved by. Effective the date the health plan approves the dependent's disabled status.
Newly Eligible for ER Contribution Employee is changing from single to family coverage and adding a dependent because they are newly eligible for employer contribution to their premiums.  1. benefit applications

1. 30 days from WRS hire/effective date or the date they are eligible for the contribution
2. 30 days from the FTE position change.
1. First of the month following date of event or date they are eligible for the contribution

2. First of the month following FTE Change Event Date
Verify that Job Data/Benefits Program Participation supports this change.
Adoption Employee is adding a dependent to their coverage due to the adoption of the dependent 1. benefit applications
2. Recorded copy of court order granting adoption or letter of placement for adoption
60 days from date of adoption


Health plans - Event Date

Life plans - First of month on or following 30 days from adoption
Adoption Resources
Marriage Employee is adding a dependent to their coverage due to marriage to the dependent benefit applications30 days of MarriageHealth plans - Date of Marriage

Life plans - First of month on or following 30 days from date of marriage
SGH: If two state employees with single coverage, first of the month following date of marriage
Marriage Resource
Domestic Partnership Enrollment Reason is not in use



REMOVE DEPENDENT

Enrollment Reason Enrollment Description \ When to Use Required Forms Received Forms Within ADM Event NOTES
Divorce Employee is removing a dependent (spouse) due to divorce 1. benefit applications
2. Completed COBRA
30 days of divorce decree date First of the month following date of divorce (if received within 30 days)

OR

Beyond 30 days, the ex-spouse will be removed prospectively first of the month following date COBRA was sent to ex-spouse/application is received
Divorce Resource
Domestic Partnership Termed Enrollment Reason is not in use



It's Your Choice Enrollment Enrollment Reason is not in use



Death of Dependent Employee is removing a dependent because of their death benefit applications No limitation [if the death results in the coverage level changing to single, premiums for the difference in premium cost between family and single coverage will only be refunded to the employer for a maximum of six months.] First of the month following receipt of application Death of Dependent Resources
Age 26 Dependent Employee is removing a dependent turning 26 because they are no longer eligible as a child dependent. Only used for health plans.  No application required
First of the month following 26th birthday of dependentChild Loses Dependent Status Due to Age Resource
Legal Guardianship Terminated Employee is removing a dependent because their legal guardianship is terminating 1. benefit application
2. Court-Ordered Notice
30 days of court-ordered notice First of the month following court-ordered notice end dateChild Loss of Dependent Status Resources
Grandchild’s Parent Turns 18 Employee is removing a grandchild dependent because the parent is turning 18. Only used for health plans. benefit application Received by 18th birthday of parent turning 18 First of the month following 18th birthday
Eligible for Other Insurance Employee is removing a dependent because the dependent has become eligible for other group health insurance.  ETF Health Insurance Application 30 days of eligible coverageFirst of the month following receipt of application
Fam to Single – Final Dep 26 Employee is removing the final dependent due to age 26 from their family plan and is changing to single coverage. Only used for health plans. benefit application30 days of dependents 26th birthdayFirst of the month following 26th birthday of dependent
Fam to Single – IYC Enrollment Reason is not in use

 
Fam to Single – Prem Increase Employee is removing all dependents from their family coverage and changing to single coverage due to a significant premium increase (>5%). Only used for SGH plans. ETF Health Insurance Application30 days of premium increaseFirst of the month following receipt of application
Fam to Single – Post Tax Employee is removing all dependents from their family coverage and changing to single because they have deductions taken post-tax. Only used for health plans. benefit application any timeFirst of the month following receipt of application

CHANGE BENEFIT PLAN

Enrollment Reason Enrollment Description \ When to Use Required Forms Received Forms Within ADM Event NOTES
Move From Service Area Employee is changing their health plan due to a move from their current service area to a new area that is not covered by their current health plan. Only used for SGH plans. ETF Health Insurance Application30 days of moveFirst of the month on or after receipt of application
It’s Your Choice Enrollment Employee is changing their health plan during the It’s Your Choice Enrollment Period Self Service or benefit applicationOpen Enrollment Period 1/1/20XX
Late It’s Your Choice Enrollment For Service Center use only; used for when employee's appeal is approved by vendor benefit applicationOpen Enrollment PeriodEvent Date is per ETF approval
Birth Employee is changing their health plan due to a birth. Only used for SGH plans. ETF Health Insurance Application60 days from Date of BirthFirst of the month on or after receipt of application
Adoption/Placement of Adoption Employee is changing their health plan due to an adoption, or a placement for adoption. Only used for SGH plans. 1. ETF Health Insurance Application
2. Recorded copy of court order granting adoption or letter of placement for adoption
60 days from date of adoptionFirst of the month on or after receipt of application
Marriage Employee is changing their health plan due to a marriage. Only used for SGH plans. ETF Health Insurance Application30 days of MarriageFirst of the month on or after receipt of application
Domestic Partnership Enrollment Reason is not in use



Loss of Other Coverage/ER Cont Employee is changing their health plan because they have lost other health coverage. Only used for SGH plans. 1. ETF Health Insurance Application
2. COBRA / Certificate of Credible Insurance
3. Letter from Previous Employer stating why coverage was lost
30 days from Loss of Coverage First of the month on or after receipt of application


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9.2 Enrollment Code Reason



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