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Reviewing the Health Opt-Out Incentive Business Process in HRS


This procedure describes the business process for employees wanting to elect the Health Opt-Out incentive. 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.

Process Considerations:

  • UW-Shared Services (UWSS) and Employee Trust Funds (ETF) determine if an employee is eligible for the Health Opt-Out Incentive.
  • Full and part-time employees under the Wisconsin Retirement System (WRS) are eligible for the Health Opt-Out Incentive. 
  • Craftworkers and Grad/Short-term Academic Staff employees are not eligible for the Health Opt-Out Incentive.
  • An employee is NEVER eligible for the Health Opt-Out Incentive if they were eligible for State Group Health insurance but declined health benefits in 2015.  
    • If a Grad employee declined health coverage in 2015, and now is in an eligible WRS position, this does NOT negate their eligibility for the Health Opt-Out Incentive.
  • An employee is not eligible for the Health Opt-Out Incentive if they are currently a dependent under the State Group Health Insurance program.
  • If an employee receives State Group Health insurance at any point during the year under a WRS contract, they are not eligible to enroll in the Health Opt-Out Incentive. The next eligible enrollment opportunity will be the Annual Benefits Enrollment (ABE) period. 
  • If an employee is on a LOA, Health Opt-Out Incentive follows the same guidelines as if they were enrolled in health insurance
    • If paid LOA, the employee is eligible for the Health Opt-Out Incentive the whole time.  
    • If unpaid LOA, the employee is eligible for the Health Opt-Out Incentive for the first three months of LOA. After the third month, Health Opt-Out Incentive will cease and be removed from HRS. 
  • If the employee is University Staff, the Health Opt-Out Incentives will begin when employer contributions begins.
  • If the employee is overpaid for the Health Opt-Out Incentive, UWSS will recoup incentive premiums by payroll or Benefits Billing.
You may click on the links below to navigate directly to a section:

Employee & Employer Share Incentive Payroll Schedule:  


Institution Process:

  1. Verify the employee completes the following sections of the State Group Health insurance application:
    • Section 1: Applicant Information
    • Section 2: Spouse Information
    • Section 12: Decline Health Insurance and Elect the Opt Out Incentive marked YES
    • Section 13: Employee signature and dated
  2. Complete the Employer Information section.
  3. Enter information in Section 11 into HRS - Benefits Personal Data page.
  4. Enroll the employee into the Health Opt-Out plan in HRS - On-Demand page.
  5. Upon notification from UWSS of approval or denial of the Health Opt-Out Incentive, contact the employee with the determination.
  6. If the employee rescinds their Health Opt-Out enrollment, update HRS to remove/change the Health Opt-Out enrollment.

UWSS Service Operations Process:

  1. Complete initial verification.
  2. Send to ETF to verify eligibility.
  3. Create a ticket with Empl_ID, Employee Name, and Health Opt-Out verification.
  4. Notify the campus of approval or denial.
    • If Health Opt-Out is denied, remove enrollment from HRS.

Additional Resources

Related KBs:

  • [Link for document 17882 is unavailable at this time.]

Related Links:

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Keywords:statutory SBC cancel waive opt out IYC new hire its your choice SGH state group health optout BN, Benefits BN, Benefits   Doc ID:57671
Owner:Christina S.Group:UW–Shared Services
Created:2015-10-21 14:21 CDTUpdated:2021-09-21 11:25 CDT
Sites:UW–Shared Services
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