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BN - Health Opt-Out Incentive Business Process


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.

  • Employees may not opt-out using Self Service.
  • The UW Service Center and ETF determine if an employee is eligible for the Opt-Out Incentive.
  • Full and part-time employees under the Wisconsin Retirement System who are enrolled in the State Group Health Insurance program in 2015 are eligible for the $2,000 Opt-Out Incentive for coverage in 2016.  An employee is NEVER eligible for health opt out if they were eligible for health insurance but declined health benefits in 2015.
  • 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 – ie 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 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.
  • 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, Benefit Administrators should 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.

warning sign Craftworkers and employees covered under the Grad/Short-term Academic Staff benefit programs, are not eligible for the $2,000 incentive, even if they decline coverage.

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.)



Institution Process:

  • Institution verifies that the employee completes the following sections of the health application:
    • Section 1: Applicant Information
    • Section 2: Spouse/Domestic Partner Information
    • Section 4: Choose to Decline/Waive Coverage box is checked
    • Section 14: Decline Health Insurance and Elect the Opt Out Incentive marked YES
    • Section 15: Employee signature and dated
  • Institution completes Section 16 for with Employer Information.
  • Benefit Administrators should be entering information from Section 11 and 12 into HRS - Benefits Personal Data Page.
  • Institution faxes completed Health Insurance Opt Out checklist and State Group Health application to UWSC Benefits Team.

UWSC Process:

  1. Do initial verification
  2. Create WISCIT with Empl ID, Empl Name and Opt Out Verification
  3. Email ETF to verify eligibility

  • Send email to institution, who then reaches out to employee with the denial decision 


  • Send email to institution, who then reaches out to the employee with approval decision
  • If University Staff, eligible once ER contributions would begin
  • Create ADM event to enroll in OPT OUT Health Plan
  • Verify benefits are correct due to ADM event processing


  • Reconcile incentives
  • Enter an ADM event with new benefit information


Related KBs:

Related Links:

Keywords:statutory SBC cancel waive opt out opt-out health incentive IYC new hire it's your choice SGH state group health optout   Doc ID:57671
Owner:Christina S.Group:Human Resource System (HRS)
Created:2015-10-21 13:21 CSTUpdated:2018-08-01 09:50 CST
Sites:Human Resource System (HRS)
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