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 WI, EPIC, VSP, State Group Life (SGL), and ICI benefits. The table below shows Enrollment Codes with their corresponding Enrollment Reasons as well as when they will typically be used.

PROCESS CONSIDERATIONS

  • Selecting the most appropriate Enrollment Code and Enrollment Reason is critical for accurate reporting to vendors such as ETF, EPIC, VSP, etc.


ENROLLMENT CODES AND REASONS

Enrollment Code
Enrollment Reason
Enrollment Description \ When to Use
Required Forms
Received Forms Within
ADM Event
Add Coverage New Hire Employee is new and adding coverage 'when employer contributes to premium'
eBenefits or ETF Health Insurance Application30 days
First of the month following 2 months of WRS Service
Add CoverageNew Hire – Coverage Start ASAPThis is not in use




Add Coverage Birth Employee is adding coverage for the first time due to a birthETF Health Insurance Application
60 days from Date of Birth
Date of Birth
Birth Resources
Add Coverage Adoption/Placement of Adoption Employee is adding coverage for the first time due to an adoption
1. ETF Health Insurance Application
2. Recorded copy of court order granting adoption or letter of placement for adoption
60 days from date of adoption
Date of Adoption
Adoption Resources
Add Coverage Nat'l Medical Support Notice Employee is adding coverage for the first time due to a court-ordered National Medical Support Notice1. ETF Health Insurance Application
2. National Medical Support Notice
30 days of the court ordered notice
Coverage 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
Add Coverage Marriage Employee is adding coverage for the first time due to their marriageETF Health Insurance Application30 days of marriage
Date of Marriage

(If 2 state employees with single coverage, first of the month following date of marriage)
Marriage Resource

If employee married their domestic partner, see DP/Marriage Resource
Add Coverage Domestic Partnership This is not in use


Add Coverage 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
ETF Health Insurance Application30 days of the event that allows the change
First of the month following qualifying event
Add Coverage Return from Unpaid LOA Employee is returning from unpaid leave of absence and is re-enrolling due to a lapse in coverageETF Health Insurance Application
30 days
First of the month following receipt of application
LOA Resource
Add Coverage 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)1. ETF Health Insurance Application
2.
COBRA/Certificate of Credible Insurance
3. Letter from Previous Employer stating why coverage was lost
30 days from the Loss of Coverage
First day following Loss of Coverage
Add Coverage Return from FMLA Leave Employee is returning from unpaid FMLA leave and is re-enrolling due to a lapse in coverage.ETF Health Insurance Application30 days
First of the month following receipt of application
LOA Resource
Add Coverage Return from Military Leave Employee is returning from a Military leave and is re-enrolling due to a lapse in coverage.ETF Health Insurance Application30 days
First of the month following receipt of application
LOA Resource
Add Coverage 1 Month Before Retirement Employee is adding coverage 1 month in advance of retirement. Employee is limited to the Standard Plan.ETF Health Insurance Application
End of the month of termination
First of the month of retirement
Add Coverage 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 required

First of the month the coverage needs to continue (If termination row has been entered)
Add Coverage
Paternity Acknowledgement Employee is adding coverage for the first time due to a Paternity Acknowledgement1. ETF Health Insurance Application
2. Notarized Paternity Acknowledgement
60 days of Paternity Acknowledgement
If 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
Add Coverage Transfer from Other Agency Employee is transferring to UWETF Health Insurance Application30 days
First of the month following Hire Date (verify coverage on Personnel Transfer Record)
Add Coverage Change Employee Type Employee is moving from regular to University Staff Temporary (LTE), or University Staff (Classified) to Unclassified, or vice versa.ETF Health Insurance Application30 days
First of the month following Job Data - Benefit Program Participation Date
Employment Changes
Add Coverage It's Your Choice Enrollment Employee is adding coverage during the It’s Your Choice Enrollment ABE PeriodeBenefits or ETF Health Insurance ApplicationOpen Enrollment Period
01/01/20XX
Cancel Coverage 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.ETF Health Insurance Application any time
First of the month following receipt of application
Cancel Coverage Unpaid Leave of Absence(Lapse) FOR UWSC Use; employee's coverage cancels due to LOA (lapse of coverage)
No application required
30 days
First of the month on or after notified by employee
LOA Checklist
Cancel Coverage 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 days
First of the month following receipt of application
Cancel Coverage 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 days
First of the month following receipt of application
Cancel Coverage Eligible for Other Coverage Employee is eligible for other coverage1. ETF Health Insurance Application
2. Copy of Proof of Other Health Coverage
30 days
First of the month following receipt of application
Cancel Coverage It's Your Choice Enrollment Employee is cancelling coverage during It’s Your Choice (Annual Benefits Enrollment)eBenefits or ETF Health Insurance ApplicationOpen Enrollment
01/01/20XX
Cancel Coverage Termination of Employment Employee wishes to cancel coverage upon termination
No application required
N/A
Cancel Coverage Retirement Employee wishes to cancel coverage upon retirement
No application required
N/A
Cancel Coverage Death of Subscriber Employee's coverage cancels due to death
ETF Health Insurance Application30 days
First of the month following date of death
Cancel Coverage Disability Approval (Non_ICI) Employee is cancelling coverage due to approval of a disability benefit
ETF Health Insurance Application30 days
First of the month following receipt of application
Cancel Coverage Benefits Billing Non-Payment FOR UWSC Use; employee's coverage cancels due to non-payment
No application required
First of the month following last paid through date
Add Dependent 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).
1. ETF Health Insurance Application
2. National Medical Support Notice
30 days
Coverage 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

Add Dependent Legal Ward Employee is adding a dependent to their coverage due to legal ward/legal guardianship1. ETF Health Insurance Application
2. Court order (Letters of Guardianship) granting permanent guardianship of person.
60 days of date of legal guardianship granted
Date of Legal Guardianship
Legal Guardianship Resources
Add Dependent Paternity Acknowledgement
Employee is adding a dependent to their coverage due 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
Add Dependent It’s Your Choice Enrollment
Employee is adding a dependent to their coverage due to the It’s Your Choice Enrollment Period
eBenefits or ETF Health Insurance ApplicationOpen Enrollment Period
 1/1/20XX
Add Dependent Birth Employee is adding a dependent to their coverage due to the dependent’s birth
ETF Health Insurance Application60 days from Date of BirthDate of Birth
Birth Resources
Add Dependent Loss of Other Coverage Employee is adding a dependent to their coverage due to the dependent’s loss of other coverage
1. ETF Health Insurance Application
2.
COBRA/Certificate of Credible Insurance
3. Letter from Previous Employer stating why coverage was lost
30 days from the Loss of Coverage
First day following Loss of Coverage
Add Dependent Not On Initial Enrollment Employee is adding a dependent younger than 19 to their coverage due to omission on the initial enrollment. 
ETF Health Insurance ApplicationNo limitation [coverage begins prospectively]First of the month on or after receipt of application
Add Dependent Disabled Dependent Over Age 26 Employee is adding a dependent to their coverage as a disabled dependent over the age of 26. 
1. ETF Health Insurance Application
2. Disability documentation
No limitationDate disabled dependent is approved by. Effective the date the health plan approves the dependent's disabled status.
Add Dependent 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. 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
Add Dependent Adoption Employee is adding a dependent to their coverage due to the adoption of the dependent
1. ETF Health Insurance Application
2. Recorded copy of court order granting adoption or letter of placement for adoption
60 days from date of adoptionDate of Adoption
Adoption Resources
Add Dependent Marriage
Employee is adding a dependent to their coverage due to marriage to the dependent
ETF Health Insurance Application30 days of Marriage
Date of Marriage

(If 2 state employees with single coverage, first of the month following date of marriage)
Marriage Resource

If employee married their domestic partner, see DP/Marriage Resource
Add DependentDomestic Partnership
This is not in use


Remove Dependent
DivorceEmployee is removing a dependent (spouse) due to divorce
1. ETF Health Insurance Application
2. Completed COBRA
30 days of divorce decree dateFirst of the month following date COBRA was sent to ex-spouse

OR

Beyond 30 days, the ex-spouse will be removed prospectively first of the month following date COBRA was sent to ex-spouse
Divorce Resource
Remove DependentDomestic Partnership TermedThis is not in use


Remove DependentIt's Your Choice EnrollmentEmployee is removing a dependent to their coverage due to the It’s Your Choice Enrollment Period (dependents under 19 cannot be removed without documentation)
eBenefits or ETF Health Insurance ApplicationOpen Enrollment Period
1/1/20XX
Remove DependentDeath of DependentEmployee is removing a dependent because of their death
ETF Health Insurance ApplicationNo 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
Remove DependentAge 26 DependentEmployee is removing a dependent turning 26 because they are no longer eligible as a child dependent
No application required

First of the month following 26th birthday of dependent
Child Loses Dependent Status Due to Age Resource
Remove DependentLegal Guardianship TerminatedEmployee is removing a dependent because their legal guardianship is terminating
1. ETF Health Insurance Application
2. Court-Ordered Notice
30 days of court-ordered noticeFirst of the month following court-ordered notice end date

Child Loss of Dependent Status Resources
Remove DependentGrandchild’s Parent Turns 18Employee is removing a grandchild dependent because the parent is turning 18
ETF Health Insurance ApplicationReceived by 18th birthday of parent turning 18First of the month following 18th birthday
Remove DependentEligible for Other InsuranceEmployee is removing a dependent because the dependent has become eligible for other group health insurance
ETF Health Insurance Application30 days of eligible coverageFirst of the month following receipt of application
Remove DependentFam to Single – Final Dep 26Employee is removing the final dependent due to age 26 from their family plan and is changing to single coverage
ETF Health Insurance Application30 days of dependents 26th birthdayFirst of the month following 26th birthday of dependent
Remove DependentFam to Single – IYCEmployee is removing all dependents from their family plan and changing to single during It’s Your Choice Enrollment
eBenefits or ETF Health Insurance ApplicationOpen Enrollment Period 1/1/20XX
Remove DependentFam to Single – Prem IncreaseEmployee is removing all dependents from their family coverage and changing to single coverage due to a significant premium increase (>5%)
ETF Health Insurance Application30 days of premium increaseFirst of the month following receipt of application
Remove DependentFam to Single – Post TaxEmployee is removing all dependents from their family coverage and changing to single because they have deductions taken post-tax
ETF Health Insurance Application any timeFirst of the month following receipt of application
Change Benefit PlanMove From Service AreaEmployee 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
ETF Health Insurance Application30 days of move
First of the month on or after receipt of application
Change Benefit PlanIt’s Your Choice EnrollmentEmployee is changing their health plan during the It’s Your Choice Enrollment Period
eBenefits or ETF Health Insurance ApplicationOpen Enrollment Period
 1/1/20XX
Change Benefit PlanBirthEmployee is changing their health plan due to a birth
ETF Health Insurance Application60 days from Date of BirthFirst of the month on or after receipt of application
Change Benefit PlanAdoption/Placement of AdoptionEmployee is changing their health plan due to an adoption, or a placement for adoption
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
Change Benefit PlanMarriageEmployee is changing their health plan due to a marriage
ETF Health Insurance Application30 days of Marriage
First of the month on or after receipt of application
Change Benefit PlanDomestic PartnershipThis is not in use


Change Benefit PlanLoss of Other Coverage/ER ContEmployee is changing their health plan because they have lost other health coverage
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


ON-DEMAND DROP DOWN MENU:

9.2 Enrollment Code Reason




Keywords:dependent, benefit enrollments, cancel coverage, change health plan, add coverage, enrollment code, codes, enrollment reasons, enrollment reason, birth, health plan, health, state group health, remove dependent, add dependent, events, on demand, on-demand, OnDemand, ETF interface, SGH, ETF, VSP, Dental WI, EPIC, EPIC+, SGL, State Group Life, ICI,   Doc ID:17490
Owner:Samantha Q.Group:Human Resource System (HRS)
Created:2011-03-27 18:00 CSTUpdated:2017-11-16 13:25 CST
Sites:Human Resource System (HRS)
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