Chapter ETF 40

ETF 40.01(4) (4) Premium payments, cancellation of coverage and refunds.

ETF 40.01(4)(a) (a) Premium payments. The insurance coverage under this section may be cancelled if premiums are not paid when due. Premiums for insurance coverage under this section shall be paid from the following sources in the following order:

ETF 40.01(4)(a)1. 1. Advance premiums payments received from the insured employee by payroll deduction, annuity deduction or direct payment for periods after the end of the month in which the insured employee died, minus any such amounts refunded to the employer.

ETF 40.01(4)(a)2. 2. The remaining balance of any converted sick leave credits under s. 40.05 (4) (b) or 40.95, Stats.

ETF 40.01(4)(a)3. 3. Deductions under s. 40.08 (2), Stats., from any annuity being paid from the Wisconsin retirement system to the responsible person, unless the annuity is insufficient to pay the monthly premium due.

ETF 40.01(4)(a)4. 4. Direct and timely payments by the responsible party.

ETF 40.01(4)(b) (b) Cancellation of coverage. A responsible person may cancel coverage for which the person is responsible. Such cancellations are effective after the end of the month in which received, unless a different effective date is expressly provided in the group health insurance contract approved by the group insurance board.

ETF 40.01 History History: Cr. Register, January, 1987, No. 373, eff. 2-1-87; CR 08-079: r. and recr. Register April 2009 No. 640, eff. 5-1-09; EmR0938: emerg. am. (2m) and (3), eff. 1-1-10; CR 10-004: am. (2m) and (3) Register July 2010 No. 655, eff. 8-1-10; CR 14-055: cr. (1) (b) (title), am. (1) (b), cr. (1) (c) (title), am. (1) (c), (2m), (a), (b) Register May 2015 No. 713, eff. 6-1-15.

ETF 40.10 ETF 40.10 Public employers health insurance.

ETF 40.10(1) (1) An employee of an employer, other than the state, shall be eligible for health insurance under s. 40.51 (7), Stats., if requirements of ss. 40.02 (46) and 40.22, Stats., or of s. 40.19 (4) (a), Stats., are satisfied. An employee of an employer that is not a participating employer shall be eligible for health insurance under s. 40.51 (7), Stats., if the requirements set forth in s. 40.02 (28) are satisfied and the following requirements are met:

ETF 40.10(1)(a) (a) The employee works at least two-thirds of what is considered full-time employment by the department.

ETF 40.10(1)(b) (b) Employment in the employee’s position is expected to last at least one year.

ETF 40.10(2) (2) As provided in a collective bargaining agreement under subch. IV of ch. 111, the employer, including an employer that is not a participating employer, shall pay an employer contribution toward the gross health insurance premium based on the lowest cost qualified plan in the service area of the employer, as follows:

ETF 40.10(2)(a) (a) For insured part-time employees who are appointed to work less than 1,044 hours per year, an amount not less than 25% of the lowest cost qualified plan.

ETF 40.10(2)(b) (b) For eligible employees not specified in par. (a) or (c), an amount between 50% and, except as provided in par. (d), 105% of the lowest cost qualified plan.

ETF 40.10(2)(c) (c) For a retiree, surviving dependent or an eligible employee on leave of absence or layoff, an employer contribution is optional.

ETF 40.10(2)(d) (d) The 105%-of-cost limitation in par. (b) does not apply to an employer that establishes an arrangement for contributing towards the premiums for employee health insurance under s. 40.51 (7), Stats., under which all of the following apply:

ETF 40.10(2)(d)1. 1. The employer contributions towards employee health insurance premiums are based upon the tier into which each available health plan is placed by the group insurance board.

ETF 40.10(2)(d)2. 2. The employee required contribution to the health insurance premium for single coverage is the same dollar amount for all plans in the same tier, regardless of the total premium. The employee required contribution to the health insurance premium for family coverage is the same dollar amount for all plans in the same tier, regardless of the total premium.

ETF 40.10(2)(d)3. 3. The employee’s required contribution to the health insurance premium for a plan classified in a higher cost tier, as compared to a plan in the next lowest cost tier, increases by at least $20 per month for single coverage and $50 per month for family coverage.

ETF 40.10(2)(d)4. 4. The employer contribution towards the premium of each qualified plan in the service area of the employer shall be an amount at least equal to the applicable minimum contribution under par. (a), (b) or (c). The employer contribution is determined by subtracting the employee contribution amount for the plans in that tier from the total plan premium for the type of coverage.

Example. Assume there are only two qualified plans in the service area of the employer. One plan is a Tier 1 plan, the other is a Tier 2 plan, and the single and family premiums are shown in the following table:

- See PDF for table

Under the tiered arrangement, a full-time employee’s premium payment for Plan A (and all Tier 1 plans that might be available, but not qualified) may be between $0 and a maximum of $190 for single coverage, depending on whether the employer is contributing the minimum amount allowed, or more. The employer must contribute no less than $200 towards single coverage, but under these circumstances must contribute at least $210 towards single coverage premium for Tier 1 plans, because that is the lowest amount that is at least equal to one-half of the lowest cost plan and also sufficient to assure both 1) that the employee contribution for single coverage under the Tier 2 plan will be at least $20 higher than the Tier 1 amount and 2) that the remainder, paid by the employer, will be at least $200. The employer contribution towards family coverage must be at least $450. This is one-half of the lowest cost plan premium for family coverage and is also sufficient to assure that the difference between the employee premiums for the Tier 1 and Tier 2 coverage is at least $50.

ETF 40.10(3) (3) Except as provided under sub. (2), the employer shall pay an employer contribution toward the gross health insurance premium based on the average premium of qualified plans in the service area of the employer, as follows:

ETF 40.10(3)(a) (a) For insured part-time employees who are appointed to work less than 1,044 hours per year, an amount not less than 25% of the lowest cost qualified plan.

ETF 40.10(3)(b) (b) For eligible employees not specified in par. (a) or (c), an amount between 50% and 88% of the average premium cost of qualified plans.

ETF 40.10(3)(c) (c) For a retiree, surviving dependent or an eligible employee on leave of absence or layoff, an employer contribution is optional.

ETF 40.10(3)(d) (d) The employer can establish an arrangement for contributing towards the premiums for employee health insurance under s. 40.51 (7), Stats., pursuant to sub. (2) (d) 1. through 4.

ETF 40.10(3)(e) (e) The group insurance board, with the advice of the actuary, may classify a health plan offered to local government employees, including local government employees of employers who are not participating employers, in a tier that is different than that of the health plan of the same name as offered to state employees.

ETF 40.10 History History: Cr. Register, December, 1987, No. 384, eff. 1-1-88; CR 04-075: am. (2) (b), cr. (2) (d) and (e) Register November 2004 No. 587, eff. 1-1-05; CR 11-040: am. (2) (intro.), r. (2) (e), cr. (3) (intro.), (a) to (e) Register July 2012 No. 679, eff. 8-1-12; CR 12-054: renum. (1) to (1) (intro.) and am., cr. (1) (a), (b), am. (2) (intro.), (3) (e) Register October 2013 No. 694, eff. 11-1-13.