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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:

  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. 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;
  5. Enroll the employee into the Health Opt-Out plan in HRS - On-Demand page.
  6. If the employee rescinds their Health Opt-Out enrollment, update HRS to remove/change the Health Opt-Out enrollment.
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UWSS Benefits Service Delivery Process:

  1. Enroll the employee into the Health Opt-Out plan in HRS - On-Demand page.
  2. If the employee rescinds their Health Opt-Out enrollment, update HRS to remove/change the Health Opt-Out enrollment.
  3. Complete initial verification.
  4. Send to ETF to verify eligibility.
  5. Create a ticket with Empl_ID, Employee Name, and Health Opt-Out verification.
  6. Notify the employee of approval or denial.
    • If Health Opt-Out is denied, remove enrollment from HRS.
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