2007/2008 State Group Health Insurance
Annual Student/Disabled Dependent Status
Sample Letter
Sample Dependent Verification Form
Processing Instructions
The Department of Employee Trust Funds (ETF) requires that participating health plans send the attached letter and Dependent Verification Form to subscribers with dependents age 19 or older (other than spouses). Participating health plans will begin mailing the letter and verification form to subscribers the week of October 22.
The deadline to return the Dependent Verification Form to the health plan is November 30, 2007. Health plans must receive verification forms by this date in order to ensure that coverage will continue on January 1, 2008. If health plans receive the verification forms after November 30, the dependent’s health insurance coverage may end as of December 31, 2007.
Note: Health plans are not allowed to accept verbal responses to the Dependent Verification Form.
Incomplete and/or unreturned verification forms may result in denied/delayed claims and prescription drug benefits for dependents.
Subscribers switching health plans during the 2008 Dual-Choice enrollment period must complete and return the Dependent Verification Form to the health plan that initiated the letter and covers the subscribers in 2007, not the new health plan selected for 2008. ETF will notify the new health plan (the subscriber’s Dual-Choice selection) of any dependent status changes based on the 2007 Dependent Verification Form.
Employees are instructed to submit a Group Health Insurance Application (ET-2301) or Health Insurance Information Change form (ET-2329), as appropriate, to the employer so that dependents may be properly deleted and COBRA continuation notifications issued. To supplement this process, ETF will then notify employers of terminated dependents in January 2008. Employers will receive a report, compiled from the data submitted by the health plans, notifying them of their subscribers’ terminated dependents. For changes from family to single coverage resulting from a change in student/disabled dependent status, employers must:
- Receive a Group Health Insurance Application (ET-2301) from any subscriber changing from family to single coverage; and
- Issue a Continuation - Conversion Notice (ET-2311) to previously covered dependent(s).
If family coverage remains in force following removal of a student/disabled dependent from coverage, employers must:
- Receive a completed Health Insurance Information Change form (ET-2329) deleting the dependent from the existing family contract; and
- Issue a Continuation - Conversion Notice (ET-2311) to previously covered dependent(s).
Dependent Reinstatement
In the event a dependent is terminated due to non-response to the health plan’s Dependent Verification Form, coverage can be reinstated back to the date of termination by the employee submitting to their payroll and benefit office of one of the following types of documentation of student status and either a Health Insurance Information Change Form (ET-2329) or a Group Health Insurance Application (ET-2301). Examples of acceptable documentation of student status include:
- Current class schedule.
- Completed Dependent Verification Form.
- Letter from the educational institution indicating the dependent is a full-time student for the current semester.
- Copy of a tuition payment receipt from the educational institution for the current semester. The receipt must indicate the total class credits taken.
See more information on adding dependents back on at:
http://www.bussvc.wisc.edu/ecbs/sgh-student-status-documentation-requirements-uw1499.html
UW1313 10/07