The Department of Employee Trust Funds (ETF) requires that participating health plans send an annual notice and Dependent Verification Form to subscribers with dependents age 19 or older (other than spouses). Participating health plans are set to mail the letter and verification form to subscribers the week of October 27. The deadline to return the Dependent Verification Form to the health plan is December 1, 2008. Health plans must receive verification forms by this date in order to ensure that coverage will continue on January 1, 2009. If health plans receive the verification forms after December 1, the dependent’s health insurance coverage may end as of December 31, 2008. 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 prescription drug benefits and claims for dependents. Subscribers switching health plans during the 2009 Dual-Choice enrollment period must complete and return the Dependent Verification Form to the health plan that initiated the letter and covered the subscribers in 2008, not the new health plan selected for 2009. ETF will notify the new health plan of any dependent status changes based on the 2008 Dependent Verification Form.

Employees are instructed to submit a Group Health Insurance Application/Change Form (ET-2301 or ET-2302) to the department payroll and benefit coordinator in order to delete dependents so that the Office of Human Resources can provide the dependent with COBRA continuation information. In January 2009, ETF will send the UW a report listing terminated dependents. This report is compiled from the dependent response data and submitted to ETF by the health plans. The Office of Human Resources will change from family to single coverage due to a change in student/disabled dependent status, request outstanding application forms to remove ineligible dependents and send COBRA information to the dependents.

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 submitting to ETF a Group Health Insurance Application/Change Form (ET-2301) adding the dependent back on the family coverage and documentation of student status. Examples of acceptable documentation of student status include one of the following: • 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.