BN - Health Opt-Out Incentive Business Process
Effective January 1, 2016, UW employees who are covered under the State Group Health Insurance program may be eligible to receive $2,000 by opting out of the program. This KB describes the business process for documenting the employee opt-out decision.
This procedure covers the Health Opt-out Incentive business process. The Department of Employee Trust Funds (ETF) and the Department of Administration -Division of Personnel (DPM) have provided the following guidance regarding the health Opt Out Incentive option.
Craftworkers, and employees covered under the Grad/Short-term Academic Staff benefit programs, are not eligible for the $2,000 incentive, even if they decline coverage.
- Employee completes the Health Insurance application, (ET-2301) electing to opt-out of health insurance.
- Employee's application needs to be received within 30 days of Date of Hire.
Employees may not opt-out using eBenefits.
- UWSC and ETF determine opt out eligibility.
- Full and part-time employees under the Wisconsin Retirement
System who are enrolled in the State Group Health Insurance program in
2015 are eligible for the $2,000 opt-out incentive for coverage in
2016. An employee is NEVER eligible for health opt out if they were
eligible for health insurance but declined health benefits in 2015.
- An employee is not eligible for health opt out if they are currently a dependent under the Health Insurance program.
- If an employee is on LOA, you need to follow the same guidelines of LOA as if they were enrolled in health insurance – ie if an employee is on full paid LOA they are eligible for health opt out the whole time. If they are on an unpaid LOA they are eligible for health opt out for the first three months and then they would not be eligible (as ER contributions would cease at that time if they were enrolled in health). They would be allowed back into Health Opt Out when they return to work. There is not an enrollment opportunity back into Health Insurance when they return from LOA (as this is based on change in premium cost to EE).
- If a GRAD declined coverage in 2015, this does NOT negate their eligibility for health opt out. They were never in a Health Opt Out eligible employment, therefore their declined status cannot affect their eligibility.
- If an employee receives health insurance through the state at any point during a year, they are not eligible for Health Opt Out until the next year IYC.
- If we give an employee too much in Health Opt Out, we should try to get the extra incentive back, either through paylines on their last paycheck or through Benefit Billing.
Employee & Employer Share - Incentive Schedule
- Institution verifies that the employee completes the following sections of the health application:
- Section 1: Applicant Information
- Section 2: Spouse/Domestic Partner Information
- Section 4: Choose to Decline/Waive Coverage box is checked
- Section 14: Decline Health Insurance and Elect the Opt Out Incentive marked YES
- Section 15: Employee signature and dated
- Institution completes Section 16 for with Employer Information.
- Benefit Administrators should be entering information from Section 11 and 12 into HRS - Benefits Personal Data Page.
- Institution faxes completed Health Insurance Opt Out checklist and State Group Health application to UWSC Benefits Team.
- Do initial verification
- Create WISCIT with Empl ID, Empl Name and Opt Out Verification
- Email ETF to verify eligibility
Send email to institution, who then reaches out to employee with the denial decision
Send email to institution, who then reaches out to the employee with approval decision
If University Staff, eligible once ER contributions would begin
Create ADM event to enroll in OPT OUT Health Plan
Verify benefits are correct due to ADM event processing
Enter an ADM event with new benefit information
Related Policies, Job Aids and Forms
Related Job Aids