BN - Add Dependent Job Aid

The following procedure will assist with adding a dependent to Health Insurances.

Procedure At-A-Glance
Category: State Group Health, Benefit Enrollments
Audience: Campus Benefit Administrators
Overarching Process: To Add Dependent for State Group Health
Navigation: Benefits > Manage Automated Enrollment > Events > On-Demand Event Maintenance
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General Description

Add Dependent Job Aid is a master list of all enrollment codes and reasons related to adding dependents for SGH and other benefits. This procedure will cover how to correctly use enrollment codes/reasons to add coverage, which drives the ETF Health Interface. Therefore, accuracy and consistency are important in maintaining this information.

Process Outputs

  • N/A

Process Considerations

  • HRS screens should be updated whenever a new Health Insurance Application ET-2301 form is submitted by employee.

Add Dependent - New Employees - Health Data Entry Steps

  1. Receive application from employee (within # of days defined by Event Table below).
  2. Employee turns in Paper Application(s) to Administrator.
  3. Review and Update Employee Information through HR - Maintain Employee Data - Biographical Details.
  4. Review and Update Benefit Personal Data through BN - Benefits Personal Data.
  5. Enter Dependent Information through BN - Add/Update Dependents.
  6. Review Job Data/Benefit Program Participation to ensure event is consistent with system data. BN - Review Health Application in relation to Job Data/Benefit Program Participation
  7. BN - Update Event Status / Review Existing Events
  8. Create an ADM event to add the dependent to Health by BN - Adding Events to the BAS Activity Table.
    1. Use ADM Event Date defined in the table below.
    2. For other plan type Event Dates please refer to Effective/Event Dates UWSA Life Event/Employment Changes charts
  9. BN - Processing an ADM Event for Health Insurance 
  10. Review enrollment through BN - Review Health Benefits Enrollments.
  11. BN - Retro Benefits Review Process
  12. Distribute forms according to Benefit Application and Form Distribution Chart.

Add Dependent Detailed Event Table

 Enrollment Code /  Event
 Description  Required Forms Receive forms within
 ADM Event Date
Birth  Employee is adding a dependent to their coverage due to the dependent's birth.
1. ETF Health Insurance Application

 60 days of birth
Date of birth
Birth/Adoption Resource
Adoption/Placement for Adoption/Legal Guardianship (Ward)
 Employee is adding a dependent to their coverage due to the adoption of the dependent. OR employee is adding a dependent to their coverage due to their status as a legal ward.
1. ETF Health Insurance Application
2. Recorded copy of court order granting adoption or letter of placement for adoption.
3. Court order (Letters of Guardianship) granting permanent guardianship of person.

*Forward copy to SC for additional processing
 60 days of adoption/placement/legal guardianship

Date of the adoption/placement/legal guardianship
Birth/Adoption Resource
Legal Guardianship Resource
Marriage
 Employee is adding a dependent to their coverage due to marriage to the dependent.1. ETF Health Insurance Application 30 days of marriage
Date of Marriage

EXCEPT
For marriage between 2 state employees with state single coverage, use first of the month following date of marriage. Must coordinate with other employer, so there is no dual coverage.

 Marriage Resource
 Domestic Partnership to Marriage Resource
Domestic Partner Employee is adding a dependent to their coverage due to the creation of a domestic partnership with the dependent.1. ETF Health Insurance Application
2. Copy of Affidavit Due to Domestic Partner

*Forward copy to SC for additional processing
 30 days of established domestic partner
Date of DP Affidavit
Domestic Partnership Resource
It's Your Choice Enrollment Period Employee is adding a dependent to their coverage due to the It’s Your Choice Enrollment Period.1. ETF Health Insurance Application Open Enrollment Period
 1/1/20xx
Loss of Coverage or Complete Loss of Employer Contribution
 Employee is adding a dependent to their coverage due to the dependent’s loss of other coverage.1. ETF Health Insurance Application
2. Letter from previous employer (indicating why losing coverage)
3. COBRA Notice, OR Certificate of Credible Insurance

*Forward copy to SC for additional processing
 30 days of the loss of coverage
 First day following loss of coverage
National 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).
1. ETF Health Insurance Application
2. Copy of National Medical Support Notice (NMSN)

*Forward copy to SC for additional processing
 30 days of the court-ordered notice
 If family coverage is already in place, coverage for the new dependent(s) is effective the first of the month on or after receipt of the application or the date specified on the NMSN, if one is specified.

See National Medical Support Notice Resource
Paternity Acknowledgement Employee is adding a dependent to their coverage due a Paternity Acknowledgement1. ETF Health Insurance Application
2. Court order declaring paternity OR Voluntary Paternity Acknowledgement with official seal filed with Department of Children & Families
3. Birth Certificate with father's name listed

*Forward copy to SC for additional processing
 60 days of Paternity Acknowledgement
 Date of Birth if received within 60 days of birth

First of the month on or after receipt of application if received beyond 60 days of birth
Not On Initial Enrollment
 Employee is adding a dependent younger than 19 to their coverage due to omission on the initial enrollment.  Dependent will be added prospectively to coverage.
Unless, the dependent is under the age of 1 and the employee had family coverage at the time of birth; the coverage will be retroactive back to the date of birth.

1. ETF Health Insurance Application No 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.  (Note: ETF does not differentiate between dependents under the age of 26, and will not accept “disabled” dependents under 26.)
1. ETF Health Insurance Application
2. Disability documentation
 No limitation
Date disabled dependent is approved by. Effective the date the health plan approves the dependent's disabled status.
Newly Eligible for Employer Contribution
 1. Employee is changing from single to family coverage and adding a dependent because they are newly eligible for employer contribution to their premiums. 
2. Employee is changing from single to family coverage and adding a dependent because they are newly eligible for the higher employer contribution.
1. ETF Health Insurance Application
(Verify that Job Data/Benefits Program Participation supports this change.)
 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

*Please note for UW Madison departments, please forward those applications needing additional processing to Madison Benefit Services (OHR).

The information provided here is meant to be a quick snapshot of policy and process as they are related to the events listed to assist you in keying in applications. For more specific information, you may reference the Department of Employee Trust Fund’s Health Insurance Administration Manual.  

Related Policies, Job Aids and Forms

Related Policies

Related Job Aids
Related Forms



Keywords:Enrollment Code Enrollment Reason Plan Types Health 10 12 13 14 Birth Adoption National Medical Support Notice Legal Ward Paternity Acknowledgement It's Your Choice Enrollment Period Loss of Coverage Not on Initial Enrollment Newly Eligible for Employer Contribution Disabled Dependent Over Age Marriage Domestic Partner Add Coverage State Group Health ETF Interface health application app health app health application benefits   Doc ID:17040
Owner:Samantha Q.Group:Human Resource System (HRS)
Created:2011-02-22 18:00 CSTUpdated:2016-11-29 16:18 CST
Sites:Human Resource System (HRS)
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