1. Navigate to: Benefits > Employee/Dependent Information > Benefits Personal Data
2. Enter the Employee's ID and click the Search button.
- This information can be found under the "Complete if you Have Additional Health/Coverage" information section 11, page 3 of the Health Insurance Application ET-2301 form as shown below:
a. If applicable, provide Effective Date and Marital Status.
other health info Updating the Marital Status here will also automatically update the Marital Status found on the "Modify a Person" HRS page.
You can obtain the Marital Status information from "Applicant Information" section 1, page 1 of the Health Insurance Application ET-2301 form as shown below.
a. This box can be ignored
The Centers for Medicare Services (CMS) will be generating new Medicare Beneficiary Identifiers (MBI) for ALL Beneficiaries to replace Medicare A and B numbers. This includes all currently active, deceased, archived, and new recipients. CMS will begin issuing new, redesigned Medicare cards containing the NEW MBI numbers beginning April 1, 2018.
- If the employee is submitting a new Medicare Beneficiary ID (MBI) number, enter the information in HRS in the Alternate Medicare Number field. Please open a ticket to the UW Shared Services who will notify ETF.
You can obtain the Medicare information from the "Complete if you are Covered by Medicare, section 7, page 3 of the Health Insurance Application ET-2301 form as shown below.
4. Click the Save button
1. Navigate to: Benefits > Employee/Dependent Information > Benefits Personal Data
2. Click the Correct History button
3. Enter the Employee's ID and click the Search button.
a. The employee's ETF Member ID is listed here. This ID is ETF's 8 digit unique identifier for the employee in their database.
If applicable, mark if the spouse is also a state employee.
b. Please select 'Yes' or 'No' to Other Health Insurance.
- If 'Yes', then list all known information regarding the other insurance using the three fields: Insurance Company Name, Insurance Policy Number, Insurance Group Number
a. Add a row. Change As of to new marital date. Change the drop down to new marital status (i.e. divorced, widowed, etc.).
b. Note the new "As of" date cannot be older than the current "As of" date.
Updating the Marital Status here will also automatically update the Marital Status found on the "Modify a Person" HRS page.
a. This box can be ignored
a. Add a row to add new Medicare information or to remove Medicare information. Leave the HIPAA Medicare Elig Reason fields blank.
If the employee is submitting a new Medicare Beneficiary ID (MBI) number, enter the information in HRS in the Alternate Medicare Number field. Please open a ticket to UW Shared Services who will notify ETF.
b. Change Effective Date to correspond to date that Medicare ends or new Medicare begins.
5. Click the Save buttonc. Remove Medicare Numbers and reasons if the employee is no longer covered by Medicare.