Running the Health Opt-Out Incentive Business Process in HRS
Overview
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. The Department of Employee Trust Funds (ETF) and the Department of Administration -Division of Personnel (DPM) have provided the following guidance regarding the health Opt Out Incentive option.This KB describes the business process for documenting the employee opt-out decision.Process Considerations:
- The UW-Shared Services and ETF determine if an employee is eligible for the Opt-Out Incentive.
- Full and part-time employees under the Wisconsin Retirement System are eligible for the $2,000 Opt-Out Incentive for coverage.
- An employee is NEVER eligible for Health Opt-Out if they were eligible for health insurance but declined health benefits in 2015. If a Grad employee declined coverage in 2015, this does NOT negate their eligibility for Health Opt-Out. They were never in a Health Opt-Out eligible employment; therefore their declined status cannot affect their eligibility.
- An employee is not eligible for Opt-Out Incentive if they are currently a dependent under the Health Insurance program
- If an employee is on LOA, you need to follow the same guidelines of LOA as if they were enrolled in health insurance – i.e. if an employee is on full paid LOA they are eligible for Opt-Out Incentive the whole time. If they are on an unpaid LOA, they are eligible for the Opt-Out Incentive for the first three months and then they would not be eligible until they return to work. (i.e. ER contributions would cease at that time if they were enrolled in health). The employee does not have an enrollment opportunity back into Health Insurance when they return from a LOA (as this is based on change in premium cost to EE).
- If an employee receives health insurance through the state at any point during a year, they are not eligible to enroll for the Opt-Out Incentive until the next It's Your Choice (ABE) period.
- If the employee is overpaid for the Opt-Out Incentive, the UWSS Service Operations will use paylines on their last paycheck or Benefit Billing to recoup the extra incentive.
- The employee's application (ET-2301) electing to opt-out of the health insurance needs to be received within 30 days of their Date of Hire.
- If the employee is University Staff, the incentive will begin when employer contributions begin.
- Craftworkers and those covered under the Grad/Short-term Academic Staff benefit programs, are not eligible for the $2,000 incentive, even if they decline coverage.
You may click on the links below to navigate directly to a section:
Employee & Employer Share - Incentive Schedule:
(The schedule indicates which pay period the Employer Share of a Health Insurance Opt-Out Incentive will be added to an employee's payroll check.)
Employee & Employer Share - Incentive Schedule:
(The schedule indicates which pay period the Employer Share of a Health Insurance Opt-Out Incentive will be added to an employee's payroll check.)
Instructions
Institution Process:
- Institution verifies that the employee completes the following sections of the health 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
- Institution completes Employer Information.
- Benefit Administrators should be entering information from Section 11 into HRS - Benefits Personal Data Page and enrolling the employee into the Health Opt-Out plan into HRS - On-Demand.
- Institutions will receive an email notifying them of the approval or denial of the Health Opt-Out decision. They will need to contact the employee with the information.
- If the employee rescinds their Health Opt-Out enrollment, the Benefit Administrator will need to update HRS to remove/change the Opt-Out enrollment.
UWSS Service Operations Process:
- Complete initial verification
- Email ETF to verify eligibility
- Create WiscIT with Empl_ID, Employee Name, and Opt Out Verification.
- Send an email to the institution on approval or denial.
- Remove Health Opt-Out Incentive enrollment from HRS
- Reconcile incentive premiums
Additional Resources
Related KBs:
Related Links:
- ETF Health Insurance Opt Out FAQ
- UWSHR State Group Health Opt-Out
- ET-2301 Health Insurance Application
- Health Insurance Opt-Out Incentive Fax Cover Sheet