Overview of Enrollment Codes and Reasons Job Aid for HRS

Overview

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.

Process Considerations:

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

Add Coverage

Enrollment ReasonEnrollment Description \ When to UseRequired FormsReceived Forms WithinADM EventNOTES
New HireEmployee is new and adding coverage 'when employer contributes to premium'Self Service or benefit applications30 daysHealth 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 ASAPEnrollment Reason is not in use



BirthEmployee is adding coverage for the first time due to a birthbenefit 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
Date of Birth
Birth Resources
Adoption/Placement of AdoptionEmployee is adding coverage for the first time due to an adoption1. 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 NoticeEmployee is adding coverage for the first time due to a court-ordered National Medical Support NoticeOnly 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
MarriageEmployee is adding coverage for the first time due to their marriagebenefit 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 PartnershipEnrollment 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 LOAEmployee 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 ContEmployee 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 LeaveEmployee 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 LeaveEmployee 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 RetirementEmployee 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
ReinstatementEmployee 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 AcknowledgementEmployee is adding coverage for the first time due to a Paternity Acknowledgement1. 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 AgencyEmployee is transferring to UW. Employee may not change existing benefits but may add enrollments for newly eligible insurancesbenefit applications30 daysFirst of the month following Hire Date (verify coverage on Personnel Transfer Record)
Change Employee TypeEmployee 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 EnrollmentEnrollment Reason is not in use




Cancel Coverage

Enrollment ReasonEnrollment Description \ When to UseRequired FormsReceived Forms WithinADM EventNOTES
Post-Tax DeductionsEmployee 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 UWSS Service Operations 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 EmploymentEmployee cancels coverage due to going part-time and being charged the less than half-time premium rateETF Health Insurance Application30 daysFirst of the month following receipt of application
Premium IncreaseWhen 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 CoverageEmployee is eligible for other coverage1. benefit applications
2. Copy of Proof of Other Health Coverage
30 daysFirst of the month following receipt of application
It's Your Choice EnrollmentEnrollment Reason is not in use



Termination of EmploymentEmployee's coverage cancel upon terminationNo application required
N/A system will automatically terminate benefits with a TER Event
RetirementEmployee's coverage cancel upon retirementNo application required
N/A system will automatically terminate benefits with a RET Event
Death of SubscriberEmployee's coverage cancels due to deathNo application required30 daysFirst of the month following date of death
Disability Approval (Non_ICI)Enrollment Reason is not in use



Benefits Billing Non-PaymentFor UWSS Service Operations use only; employee's coverage cancels due to non-paymentNo application required
First of the month following last paid through date

Adding Dependents


Enrollment ReasonEnrollment Description \ When to UseRequired FormsReceived Forms WithinADM EventNOTES
Nat'l Medical Support NoticeEmployee 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 WardEmployee 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 GuardianshipLegal Guardianship Resources
Paternity AcknowledgementEmployee is adding a dependent to their coverage due a Paternity Acknowledgement1. 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 EnrollmentEnrollment Reason is not in use


 
BirthEmployee is adding a dependent to their coverage due to the dependent’s birthbenefit 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 CoverageEmployee 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 EnrollmentEmployee 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 26Employee 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 ContributionEmployee 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.
AdoptionEmployee is adding a dependent to their coverage due to the adoption of the dependent1. 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
MarriageEmployee is adding a dependent to their coverage due to marriage to the dependentbenefit 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 PartnershipEnrollment Reason is not in use



Removing Dependents


Enrollment ReasonEnrollment Description \ When to UseRequired FormsReceived Forms WithinADM EventNOTES
DivorceEmployee is removing a dependent (spouse) due to divorce1. benefit applications
2. Completed COBRA
30 days of divorce decree dateFirst 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 TermedEnrollment Reason is not in use



It's Your Choice EnrollmentEnrollment Reason is not in use



Death of DependentEmployee is removing a dependent because of their deathbenefit applicationsNo 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 date of death
Death of Dependent Resources
Age 26 DependentEmployee 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 TerminatedEmployee is removing a dependent because their legal guardianship is terminating1. benefit application
2. Court-Ordered Notice
30 days of court-ordered noticeFirst of the month following court-ordered notice end dateChild Loss of Dependent Status Resources
Grandchild’s Parent Turns 18Employee is removing a grandchild dependent because the parent is turning 18. Only used for health plans.benefit applicationReceived by 18th birthday of parent turning 18First of the month following 18th birthday
Eligible 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
Fam to Single – Final Dep 26Employee 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 – IYCEnrollment Reason is not in use

 
Fam to Single – Prem IncreaseEmployee 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 TaxEmployee 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 applicationany timeFirst of the month following receipt of application

Changing Benefit Plans

Enrollment ReasonEnrollment Description \ When to UseRequired FormsReceived Forms WithinADM EventNOTES
Move 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. 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 EnrollmentEmployee is changing their health plan during the It’s Your Choice Enrollment PeriodSelf Service or benefit applicationOpen Enrollment Period 1/1/20XX
Late It’s Your Choice EnrollmentFor UWSS Service Operations use only; used for when employee's appeal is approved by vendorbenefit applicationOpen Enrollment PeriodEvent Date is per ETF approval
BirthEmployee 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 AdoptionEmployee 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
MarriageEmployee 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 PartnershipEnrollment Reason is not in use



Loss of Other Coverage/ER ContEmployee 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 CoverageFirst 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, Delta Dental, SGL, State Group Life, ICI, BN, Benefits BN, Benefits   Doc ID:17490
Owner:Joanna B.Group:UW–Shared Services
Created:2011-03-27 19:00 CDTUpdated:2020-09-14 08:56 CDT
Sites:Human Resource System (HRS), UW-La Crosse, UW–Shared Services
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