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Reviewing the Health Opt-Out Incentive Business Process in HRS
Overview
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 and Craftworkers under the Wisconsin Retirement System (WRS) are eligible for the Health Opt-Out Incentive.
- 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.
- Employee and Employer share incentive payments are paid on the 1st and 2nd payrolls paid in a Month.
- The Health Opt-Out Incentive is not paid on the 3rd payroll paid in a month.
You may click on the links below to navigate directly to a section:
Instructions
Institution Process:
- 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
- Complete the Employer Information section.
- Enter information in Section 11 into HRS - Benefits Personal Data page.
- Send the State Group Health insurance application to UW-Shared Services, Benefits Service Delivery team (if using Benefits Service Delivery).
If not using Benefits Service Delivery then; - Enroll the employee into the Health Opt-Out plan in HRS - On-Demand page.
- If the employee rescinds their Health Opt-Out enrollment, update HRS to remove/change the Health Opt-Out enrollment.
UWSS Benefits Service Delivery Process:
- Enroll the employee into the Health Opt-Out plan in HRS - On-Demand page.
- If the employee rescinds their Health Opt-Out enrollment, update HRS to remove/change the Health Opt-Out enrollment.
- Complete initial verification.
- Send to ETF to verify eligibility.
- Create a ticket with Empl_ID, Employee Name, and Health Opt-Out verification.
- Notify the employee of approval or denial.
- If Health Opt-Out is denied, remove enrollment from HRS.