BN - Coding Insurance Applications

GENERAL DESCRIPTION:

All applications have a section that must be completed by the institution Benefit Administrator prior to being forwarded to the vendor and prior to entering the enrollments in HRS. This document provides information on how to accurately code insurance applications.

PROCESS CONSIDERATIONS:
  • Institution Benefit Administrators are responsible for verifying that all applications are filled out completely prior to coding the application and prior to the information being forwarded to the vendor.  Incomplete applications can cause many downstream impacts on deductions, receipt of insurance cards, initial rejection of the employee's enrollment information, and/or delayed or denied claims. 
  • Applications must be coded on a timely basis to ensure that whenever feasible, data entry is completed prior to the end of the enrollment window.



STATE GROUP HEALTH

The Employer Completes section of the ETF State Group Health application is located on page 4 of the application as shown below. 

Regardless of whether the employee is enrolling for the first time as a newly benefit eligible employee, or is making a change because of a Qualifying Event, the Institution Benefit Administrator must verify all fields on the application have been filled in appropriately and complete the "Employer Completes" section before entering the information in HRS and forwarding the application to ETF.

SGH_ER_Section_2019

  1. EIN:  Enter 0001131
  2. Employer Name:  University of Wisconsin
  3. Payroll Representative Email:  Institution Benefit Administrator's business email address
  4. Group Number:  83445
  5. Employee Type:  Enter '03' for University Staff, '04' for Faculty, Academic Staff, or Limited Appointee, or '12' for Grad Assistant
  6. Coverage Type:  check either Single or Family coverage
  7. Health Plan Name/Suffix:  Click here for a list of health plans and suffix codes:  ETF 2019 Health Codes
  8. Business Unit:  Enter your Institution Name (i.e. UW-Madison, UW-Stout, UW-Eau Claire...etc)
  9. Employment Status of Applicant:  Indicate if the employee is a Full, Part Time, or an LTE.
  10. Employee Deductions:  Check whether the premiums will be deducted from an employee's payroll check before or after federal and state taxes.
  11. Hire Date or WRS Eligible Employment Date or Grad Appointment Began:  This date must reflect an employee's original date of hire OR the date they became eligible for the Wisconsin Retirement System (WRS) benefits.  If the employee is not eligible for the WRS, indicate the date they began the appointment that made them eligible for Grad benefits.
  12. Employer Received Date:  Indicate the date you physically received the completed, signed, and dated health insurance application
  13. Event Date: 

    • New Hire:  Enter first of the month following two months of employment for University Staff (biweekly paid) employees if the employee chooses to wait for the employer contribution to their premium.  Enter the first of the month on or following the Date of Hire for a Grad or FA/AS/LI (monthly paid) employee.
    • Newly Eligible for benefits:  University Staff:  Enter the first day of the month following two months of employment from the date they became eligible for the WRS if the employee chooses to wait for the employer contribution to their premium.  Grad or FA/AS/LI:  Enter the first of the month on or following the date they became eligible for the WRS.
    • Qualifying Event:  Enter the date of the qualifying event (i.e. date of divorce, date of baby's birth, date child is placed for adoption, date of marriage, etc.)

  14. Prospective Coverage Change:  The effective date for the new or changing coverage.  For more information on prospective coverage change effective dates, please visit the UWSHR website.)
  15. Answer the following questions regarding previous State/Local WRS Service.  For information on how to look up this information on the ETF One Net system, click here.

    • Are you a WRS Participating employer?  Answer:  Yes
    • Previous Service Check Completed?  Answer:  Yes  (if this employee appears on the New Hire Hold report, you must manually look up the employee previous service on the ETF system.)
    • Source of Previous Service Check?  Answer:  If this is an employee with no prior service or you manually verified this information on the ETF One system, the answer is "Online Network for Employers."  If you called ETF on the phone to obtain this information, the answer is "ETF."
    • Did employee participate in the WRS prior to being hired by you?  Answer:  If the employee appears in the ETF One system, answer this question as "yes," otherwise answer this question as "no."

  16. Payroll Representative Signature:  Institution Benefit Administrators must sign every application to verify that the employee works for the University, that they have agreed to payroll deductions to pay for premiums, and that they are eligible to enroll.
  17. Phone Number:  Enter your business phone number
  18. Date Signed:  Institution Benefit Administrators must date every application to indicate that the application was completed on a timely basis.



EPIC / DENTAL WISCONSIN


The "For Office Use Only" employer section is found at the bottom of page 2 of the EPIC and Dental Wisconsin applications.  This section is identical for the two plans and is completed the same way.

EPIC
  1. Date Rec'd:  Indicate the date you physically received the completed, signed, and dated Dental Wisconsin or EPIC insurance application
  2. Received by:  The name of the individual completing this section of the application
  3. Hire Date:  This date must reflect an employee's original date of hire OR the date they became eligible for the Wisconsin Retirement System (WRS) benefits.  If the employee is not eligible for the WRS, indicate the date they began the appointment that made them eligible for Grad benefits.
  4. Cov Eff Date:  Enter the first day of the month following two months for a University Staff (biweekly paid) employee if they choose to have it coincide with the employer contribution to their State Group Health insurance.  Enter the first day of the month on or following the date of hire for a (monthly paid) FA/AS/LI or Grad employee.  For a Qualifying Event, enter the date of the Qualifying Event.
  5. Agency/Campus Code:  Enter your Institution Name (i.e. UW-Madison, UW-Stout, UW-Eau Claire...etc)
  6. EPIC Group Number:  Enter '31800' for EPIC or '31800D' for Dental Wisconsin
  7. Division Number:  Leave this field blank
  8. Affidavit of domestic partnership on file:  This field is no longer used as of 1/1/2018.  Leave blank
  9. Premium:  Leave this field blank

VISION INSURANCE PLAN (VSP)

The "For Office Use Only" employer section is located at the bottom of the VSP application.

VSP
  1. Employee ID:  Enter '0' plus the employee's HRS Empl_ID (i.e.  099999999)
  2. Hire Date:  This date must reflect an employee's original date of hire OR the date they became eligible for the Wisconsin Retirement System (WRS) benefits.  If the employee is not eligible for the WRS, indicate the date they began the appointment that made them eligible for Grad benefits.
  3. Location:  Enter your Institution Name (i.e. UW-Madison, UW-Stout, UW-Eau Claire...etc)
  4. Coverage/Change Effective Date: 

    • New Hire:  Enter first of the month following two months of employment for University Staff (biweekly paid) employees if the employee chooses to wait for the employer contribution to their premium.  Enter the first of the month on or following the Date of Hire for a Grad or FA/AS/LI (monthly paid) employee.
    • Newly Eligible for benefits:  University Staff:  Enter the first day of the month following two months of employment from the date they became eligible for the WRS if the employee chooses to wait for the employer contribution to their premium.  Grad or FA/AS/LI:  Enter the first of the month on or following the date they became eligible for the WRS.
    • Qualifying Event:  Enter the date of the qualifying event (i.e. date of divorce, date of baby's birth, date child is placed for adoption, date of marriage, etc.)

  5. Date Received:  Indicate the date you physically received the completed, signed, and dated Vision Insurance Plan application
  6. Received By:  The name of the individual completing this section of the application
  7. Group #:  Enter 30027840 / 0001 / 0001

STATE GROUP LIFE INSURANCE

The "Employer Completes" section is located at the bottom of page 3 of the State Group Life Insurance Application:
SGL
  1. ETF Employer Number:  Enter 69-036-0001-131
  2. Name of Employer:  Enter your Institution Name (i.e. UW-Madison, UW-Stout, UW-Eau Claire...etc)
  3. Employer Billing Unit Number:  Enter 1131
  4. Employer Agent Signature:  Signature of the individual completing this section of the application
  5. Prepare By:  The name of the individual completing this section of the application
  6. Telephone Number:  Enter the business phone number for the individual completing this section of the application
  7. Date WRS employment began with current employer (mm/dd/ccyy):  This date must reflect the date they became eligible for the Wisconsin Retirement System (WRS) benefits with the University.
  8. Date Provided to Employee (mm/dd/ccyy):  Enter the date you provided this application to the employee to complete
  9. Date Received From Employee (mm/dd/ccyy):  Indicate the date you physically received the completed, signed, and dated  State Group Life Insurance application
  10. Coverage Effective Date: 

    • New Hire:  Enter first of the month following 30 days of employment for all employees.
    • Newly Eligible for benefits:  Enter first of the month following 30 days they became eligible for the WRS benefits.
    • Qualifying Event:  Coverage is effective on the first of the month on or following 30 days from qualifying event (i.e. date of divorce, date of baby's birth, date child is placed for adoption, date of marriage, etc.)

  11. Calendar Year Earnings:  Enter the annual salary that premiums will be based on.  Follow the rules for setting up Annual Benefit Base Rates (ABBRs) in KB 17090.
  12. Earnings Are:  Check whether the salary amount entered under number #11 is an estimated salary or an actual salary based on the previous year's WRS qualified earnings.

INDIVIDUAL & FAMILY LIFE INSURANCE

The "For Office Use Only" section is located at the bottom of page 3 of the Individual and Family Life Insurance Application:

Ind and Fam
  1. Date Received by employer:  Indicate the date you physically received the completed, signed, and dated  Individual and Family Life Insurance application
  2. Received by:  The name of the individual completing this section of the application
  3. Hire/Event Date:  Original date the employee became benefit eligible
  4. Coverage Effective Date:  First day the employee should be covered by the insurance
  5. li>UWS Affidavit:  Indicate if the employee has a UWS Domestic Partner Affidavit on file or if this is Not Applicable (N/A)  Please note that the ETF Affidavit no longer applies as of 1/1/2018.
  6. Premium: Enter the calculated premium based on coverage level and age (click here to use the on line calculator for premiums).
  7. li>Processor Initials:  Enter your initials
  8. Employee ID:  Enter the employee's HRS 8 digit Empl_ID

UW EMPLOYEE'S INC. LIFE INSURANCE


This section is found at the bottom of the application page.
UW EE
  1. Date Received:  Enter the date you received the application from the employee
  2. Received By:  Enter your name
  3. Hire Date:  Enter the original date the employee became benefit eligible
  4. Coverage Effective Date:  First day the employee should be covered by the insurance
  5. Premium: Enter the calculated premium based on coverage level and age (click here to use the on line calculator for premiums).
  6. Processors Initials:  Enter your initials
  7. Date Processed: Enter the date you are completing the Employer Section of this application
  8. Employee ID:  Enter the employee's HRS 8 digit Empl_ID

ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE (AD&D)


This sectionis found on the bottom of page 2 of the application.
ADD
  1. Date Received by Employer:  Enter the date (MM/DD/YY) you received the application from the employee
  2. Received By:  Enter your name
  3. Hire Date:  Enter the date the employee became benefit eligible (MM/DD/YY)
  4. Coverage Effective Date:  First day the employee should be covered by the insurance
  5. Premium:  Enter the calculated premium based on coverage level (click here for a list of premiums)
  6. Processor Initials:  Enter your initials
  7. Person ID:  Enter the employee's HRS 8 digit Empl_ID
  8. Has employee establish a domestic partnership:  Check Yes or No if the employee is covering a domestic partner.  (Please note that the ETF Affidavit no longer applies as of 1/1/2018) 



INCOME CONTINUATION INSURANCE


The employer must complete page 2 of the application.
ICI
  1. APPLICATION INFORMATION

    • Enter the date you provided the application to the employee
    • Enter the date you received the application back from the employee
    • Reason to submit application:

      • Check the appropriate box depending the enrollment circumstance
      • List the date(s) based on the checkbox you indicated

    • UW/Faculty Academic Staff Only - this checkbox is used only in the event a FA/AS/LI employee is requesting to change to a longer elimination period
    • Answer questions 1,2, and 3 regarding the employee's prior WRS service.  (For more information, please reference:  BN - Looking up Prior WRS Service in ETFOne )

  2. EARNINGS

    • Check the appropriate box to indicate if this employee is paid biweekly or monthly
    • Check the box to indicate if the employee is full time (40 hours per week), part time (please indicate their FTE percentage), seasonal, academic (9 Month or C-Basis), a Project employee, or an LTE.
    • Enter the projected employer and employee shares of the monthly ICI premium.  (Click here for premium information)
    • If the employee is enrolling in the ICI Supplemental plan, enter the employee's premium.  If the employee is not enrolling in ICI Supplemental, leave this field blank.

  3. SICK LEAVE INFORMATION

    • This section is completed for employees who are enrolling for Deferred Coverage, they are being Reinstated, or they are Rehires.  Otherwise this section is left blank.
    • Enter the accumulated sick leave credits for the preceding two calendar years for the employee in this section.  (calendar years listed may vary from the screenshot above)

      • Enter the beginning sick leave balance for the calendar year
      • Enter the sick leave earned for that calendar year
      • Enter the sick leave used during that calendar year
      • Enter the sick leave balance at the end of that calendar year
      • Repeat these steps for the second year of information

  4. EMPLOYER INFORMATION
    • Employer Name:  Your institution name (UW-Stout, UW-Madison, etc.)
    • EIN:  Enter 69-036-0001131
    • Employer Agent Signature:  Sign your name as the processor
    • Telephone:  Enter your work phone number
    • Effective Date: First day the employee should be covered by the insurance: 


TASC FLEXIBLE SPENDING ACCOUNTS & LIMITED PURPOSE FLEXIBLE SPENDING ACCOUNTS


This section is found at the top of the application.
TASC flexible spending account
  1. Employer Name:  Enter your institution name (UW-Stout, UW-Madison, etc.)
  2. Employee ID:  Enter the employee's HRS 8 digit Empl_ID
  3. Participant Plan Effective Date:   First day the employee should be covered by the salary deferral plan
  4. Date of First Payroll:  Enter the first day of the payroll period when deductions will begin.  Click here for the Payroll Calendar)
    /li>

ADDITIONAL RESOURCES:

Related KBs:

Related Links:



Keywords:app, apps, code,   Doc ID:77301
Owner:Samantha Q.Group:Human Resource System (HRS)
Created:2017-10-11 13:04 CDTUpdated:2018-09-14 10:14 CDT
Sites:Human Resource System (HRS)
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