Enrollment Codes and Reasons

Add Coverage

Enrollment Reason	Enrollment Description \ When to Use	Required Forms	Received Forms Within	ADM Event	NOTES
New Hire	Employee is new and adding coverage 'when employer contributes to premium'	Self Service or benefit applications	30 days	Health 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 ASAP	Enrollment Reason is not in use
Birth	Employee is adding coverage for the first time due to a birth	benefit applications SGH: Notarized Maternity Acknowledgement, if employee adding child is single	60 days from Date of Birth	Health 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 Adoption	Employee is adding coverage for the first time due to an adoption	1. benefit applications SGH: 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 date of adoption	Date of Adoption Adoption Resources
Nat'l Medical Support Notice	Employee is adding coverage for the first time due to a court-ordered National Medical Support Notice	Only used for Health plans 1. benefit applications 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
Marriage	Employee is adding coverage for the first time due to their marriage	benefit applications	30 days of marriage	Health 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 Partnership	Enrollment 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 applications	30 days of the event that allows the change	First of the month following app received date
Return from Unpaid LOA	Employee is returning from unpaid leave of absence and is re-enrolling due to a lapse in coverage.	benefit applications	30 days	First of the month following return to work date	LOA Resource
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). 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 Coverage	First day following Loss of Coverage
Return from FMLA Leave	Employee is returning from unpaid FMLA leave and is re-enrolling due to a lapse in coverage.	benefit applications	30 days	First of the month following return to work date	LOA Resource
Return from Military Leave	Employee is returning from a Military leave and is re-enrolling due to a lapse in coverage.	benefit applications	30 days	First of the month following return to work date	LOA Resource
1 Month Before Retirement	Employee is adding coverage 1 month in advance of retirement. Employee is limited to the Standard Plan. Only used for SGH plans.	ETF Health Insurance Application	End of the month of termination	First of the month of retirement
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	If 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 Acknowledgement	Employee is adding coverage for the first time due to a Paternity Acknowledgement	1. 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
Transfer from Other Agency	Employee is transferring to UW. Employee may not change existing benefits but may add enrollments for newly eligible insurances	benefit applications	30 days	First of the month following Hire Date (verify coverage on Personnel Transfer Record)
Change Employee Type	Employee is moving from regular to University Staff Temporary (LTE), or University Staff to FA/AS/LI, or vice versa.	ETF Health Insurance Application	30 days	First of the month following Job Data - Benefit Program Participation Date	Employment Changes
It's Your Choice Enrollment	Enrollment Reason is not in use

Cancel Coverage

Enrollment Reason	Enrollment Description \ When to Use	Required Forms	Received Forms Within	ADM Event	NOTES
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. Also used for employees voluntary cancelling life plans or ICI.	benefit applications	any time	First 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 required	30 days	First of the month on or after notified by employee	LOA Checklist
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 Application	30 days	First of the month following receipt of application
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 Application	30 days	First of the month following receipt of application
Eligible for Other Coverage	Employee is eligible for other coverage	1. benefit applications 2. Copy of Proof of Other Health Coverage	30 days	First of the month following receipt of application
It's Your Choice Enrollment	Enrollment Reason is not in use
Termination of Employment	Employee's coverage cancel upon termination	No application required		N/A system will automatically terminate benefits with a TER Event
Retirement	Employee's coverage cancel upon retirement	No application required		N/A system will automatically terminate benefits with a RET Event
Death of Subscriber	Employee's coverage cancels due to death	No application required	30 days	First of the month following date of death
Disability Approval (Non_ICI)	Enrollment Reason is not in use
Benefits Billing Non-Payment	For UWSS Service Operations use only; employee's coverage cancels due to non-payment	No application required		First of the month following last paid through date

Adding Dependents

Enrollment Reason	Enrollment Description \ When to Use	Required Forms	Received Forms Within	ADM Event	NOTES
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). Only used for health plans.	1. benefit applications 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
Legal Ward	Employee 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 Guardianship	Legal Guardianship Resources
Paternity Acknowledgement	Employee is adding a dependent to their coverage due a Paternity Acknowledgement	1. benefit applications 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.	WHDS Paternity Resources Birth Resources
It’s Your Choice Enrollment	Enrollment Reason is not in use
Birth	Employee is adding a dependent to their coverage due to the dependent’s birth	benefit applications SGH: Notarized Maternity Acknowledgement, if employee adding child is single and female	60 days from Date of Birth	Health plans - Date of Birth Life plans - First of month on or following 30 days from date of birth	Birth Resources
Loss of Other Coverage	Employee 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 Coverage	First day following Loss of Coverage
Not On Initial Enrollment	Employee 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 Application	No limitation [coverage begins prospectively]	First of the month on or after receipt of application
Disabled Dependent Over Age 26	Employee 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 limitation	Date disabled dependent is approved by. Effective the date the health plan approves the dependent's disabled status.
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. 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.
Adoption	Employee is adding a dependent to their coverage due to the adoption of the dependent	1. 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
Marriage	Employee is adding a dependent to their coverage due to marriage to the dependent	benefit applications	30 days of Marriage	Health 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 Partnership	Enrollment Reason is not in use

Removing Dependents

Enrollment Reason	Enrollment Description \ When to Use	Required Forms	Received Forms Within	ADM Event	NOTES
Divorce	Employee is removing a dependent (spouse) due to divorce	1. benefit applications 2. Completed COBRA	30 days of divorce decree date	First 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 Termed	Enrollment Reason is not in use
It's Your Choice Enrollment	Enrollment Reason is not in use
Death of Dependent	Employee is removing a dependent because of their death	benefit applications	No 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 Dependent	Employee 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 dependent	Child Loses Dependent Status Due to Age Resource
Legal Guardianship Terminated	Employee is removing a dependent because their legal guardianship is terminating	1. benefit application 2. Court-Ordered Notice	30 days of court-ordered notice	First of the month following court-ordered notice end date	Child Loss of Dependent Status Resources
Grandchild’s Parent Turns 18	Employee is removing a grandchild dependent because the parent is turning 18. Only used for health plans.	benefit application	Received by 18th birthday of parent turning 18	First of the month following 18th birthday
Eligible for Other Insurance	Employee is removing a dependent because the dependent has become eligible for other group health insurance.	ETF Health Insurance Application	30 days of eligible coverage	First of the month following receipt of application
Fam to Single – Final Dep 26	Employee 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 application	30 days of dependents 26th birthday	First of the month following 26th birthday of dependent
Fam to Single – IYC	Enrollment Reason is not in use
Fam to Single – Prem Increase	Employee 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 Application	30 days of premium increase	First of the month following receipt of application
Fam to Single – Post Tax	Employee 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 application	any time	First of the month following receipt of application

Changing Benefit Plans

Enrollment Reason	Enrollment Description \ When to Use	Required Forms	Received Forms Within	ADM Event	NOTES
Move From Service Area	Employee 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 Application	30 days of move	First of the month on or after receipt of application
It’s Your Choice Enrollment	Employee is changing their health plan during the It’s Your Choice Enrollment Period	Self Service or benefit application	Open Enrollment Period	1/1/20XX
Late It’s Your Choice Enrollment	For UWSS Service Operations use only; used for when employee's appeal is approved by vendor	benefit application	Open Enrollment Period	Event Date is per ETF approval
Birth	Employee is changing their health plan due to a birth. Only used for SGH plans.	ETF Health Insurance Application	60 days from Date of Birth	First of the month on or after receipt of application
Adoption/Placement of Adoption	Employee 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 adoption	First of the month on or after receipt of application
Marriage	Employee is changing their health plan due to a marriage. Only used for SGH plans.	ETF Health Insurance Application	30 days of Marriage	First of the month on or after receipt of application
Domestic Partnership	Enrollment Reason is not in use
Loss of Other Coverage/ER Cont	Employee 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 Coverage	First of the month on or after receipt of application

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