Benefits Update Beth Ritchie

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Benefits Update Beth Ritchie

• Topics
• Resumption of ER-paid SGH after a LOA
• COBRA Premium Assistance
• Proof of marriage - cultural issues
• HealthPartners - new health plan for 2010
• New LTC plan from John Hancock
• ICI premium increase

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Benefits Update Beth Ritchie

• Resumption of ER-paid SGH after a LOA
• Following a leave of absence, the employee is
  entitled to the employer contribution for health
  insurance for the coverage month which begins on
  the
• 1st of the month on or after the employee returns
  to work if the employee has prepaid the premium
  to keep coverage in force. Refund overpayment
  by employee.
• 1st of the month on or after the employee returns
  to work and submits a new application if coverage
  lapsed.

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Benefits Update Beth Ritchie

• Adjustments to the employer contributions will be
  necessary to bring coverage/premium current.
• The employee must RTW for at least 50 for 30
  days to be eligible for the employer share. If
  employee fails to do so we will recoup the
  employer share of premium.

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Benefits Update Beth Ritchie

• COBRA Premium Assistance
• Include the completed Request to be Considered an
  Assistance Eligible Individual and COBRA
  continuation form to the plans, including the
  optional plans.
• Resident Aliens are not eligible for ARRA

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Benefits Update Beth Ritchie

• If an employee retires in lieu of an involuntary
  termination the employee has the following
  options
• Take an Immediate Annuity Through the WRS
  Within 30 days of termination, submit a
  Retirement Estimate and Benefit Application (form
  ET-4301) to ETF to apply for an immediate
  annuity. By taking an immediate annuity
• Family health insurance coverage will continue
  under the Program as an annuitant.
• Accumulated sick leave credits can be used for
  the premium.
• Spouse has survivor rights under the program to
  continue health insurance coverage indefinitely.
• Not eligible for COBRA.
• OR
•  

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Benefits Update Beth Ritchie

• Delay the start of the WRS Annuity By delaying
  the start of the annuity through the WRS, COBRA
  continuation coverage may be elected. By
  delaying the annuity
• COBRA continuation coverage is available for up
  to 36 months.
• There may be eligibility for the ARRA premium
  assistance for up to nine months.
• Accumulated sick leave is not available for
  conversion to pay premium.
• Spouse has no survivor rights while covered on
  COBRA continuation coverage.

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Benefits Update Beth Ritchie

• Cultural Marriages
• Some cultures, such as the Hmong, have common law
  marriages that are recognized within the
  community.
• To be eligible as a dependent spouse for health
  or state group life insurance

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Benefits Update Beth Ritchie

• Misc. State Group Health Issues
• The Medicare, Medicaid and SCHIP Extension Act of
  2007 (MMSEA) requires health insurers to collect
  the social security numbers for all members. The
  SSNs must be reported for all members age 55 or
  older or on Medicare. This is to ensure that
  Medicare pays as the secondary carrier when there
  is active employee coverage in force (including
  for dependents.
• Plans may be fined 1,000 per day per violation.

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Benefits Update Beth Ritchie

• Because of penalties, CMS informally advised
  insurers to refuse to issue coverage if member
  refuses to provide SSN.
• More recently, the Center for Medicare and
  Medicaid Services (CMS) said penalties will not
  be applied to resident aliens as they cannot
  collect Medicare or Medicaid.
• If you hear of any resident alien being denied
  coverage because they could not provide an SSN,
  contact Beth Ritchie.

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Benefits Update Beth Ritchie

• Health Partners is a new health plan that will be
  offered in 2010.
• It has providers in Minnesota and extends into
  the following counties in northwestern Wisconsin
  Burnett, Douglas, Pierce, Polk and St. Croix.
• New plans are not qualified in the first year
  of participation. If a qualified HMO is not
  available in any of these counties, SMP will be
  offered in 2010.

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Benefits Update Beth Ritchie

• The Dual-Choice Enrollment period will now be
  called the Its Your Choice Enrollment period.
• The Its Your Choice Enrollment period is October
  5 23, 2009.
• The Its Your Choice Kick-Off meeting will be
  held in Madison on September 23 from 900 1130
  a.m.

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Benefits Update Beth Ritchie

• Effective February 1, 2010, ICI premiums will
  increase by 7.
• The ICI reserve fund took a hit from the market
  downturn and had a 15 increase in liabilities. 
  It currently has assets of 60.4 million and
  estimated liabilities of 72.8 million. 
• The actuary expects additional increases of about
  7 for 2112 and 2014 to help get the fund back to
  target levels.  Historically the target has been
  to maintain a net fund balance of 15 - 25 of
  estimated liabilities.

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Benefits Update Beth Ritchie

• Standard Plan/SMP Fun Facts
• Standard Plan
• 41 are over age 55 (benchmark is 17)
• 72 of members live in WI, 25 of whom live in
  Dane County and 14 live in Milwaukee County.
• Members in 45 states and 11 international
  locations
• Almost 50 live along WI borders
• 20 reside in CA, FL, AZ, TX
• 51 members account for 27 of claims. All
  incurred claims over 100,000.
• Members pay 2.6 of medical claim costs
  (benchmark is 7)

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Benefits Update Beth Ritchie

• SMP
• 55 are over age 45 (benchmark is 35)
• 96 of members live in WI, 25 of whom live in
  Dane County and 14 live in Milwaukee County.
• Members pay less than 1 of medical costs.
  Members in most large groups pay 7.