Changes to Employee Information

City of Madison Information

The City of Madison needs up to date employee home address and telephone numbers. All employees are required to provide their department/division heads or designees with up to date home addresses and telephone numbers within 10 working days of changes in address and/or phone number. The Change of Address or Telephone Number Form should be submitted to the employee's Payroll Clerk. See APM 2-37.

Employee information may also be changed on ESS.

Employees who wish to change their gender or racial identification with the City may fill out an Employee Self-Identification Form and submit it to Human Resources.

Benefit Information

In addition, employees may have to update benefit information in the event of a change of Name, Address, Beneficiary, or Family Status. Please note that some may have time limits.

Name Change Address Change Beneficiary Change Family Status Change Form Completed by Submitted to
x x     Personnel Action Form Payroll Clerk Central Payroll
x     May be needed W-4 & Wisconsin Withholding Agreement Employee Central Payroll
x   x May be needed Wisconsin Retirement System
Beneficiary Designation: ET-2320 or ET-2321 (more complex designations)
Employee ETF
x x     Wisconsin Retirement System
Address/Name Change Form ET-2815
Employee ETF
x ETF online   Time limits Health Insurance Application ET-2301
ETF online instructions
Employee Human Resources
OR ETF online
x     Time limits Dental Enrollment/Change/Waiver Employee Human Resources
x     Time limits Life Insurance Enrollment Change form
Available from Human Resources
Employee Human Resources
x   x May be needed Life Insurance Beneficiary Change Form
Available from Human Resources
Employee Human Resources
x   x May be needed Wage Insurance Salary Protection Enrollment Card
Available from Human Resources
Employee Human Resources
x x x   Deferred Compensation
Online at plan website: Alliance | ICMA-RC
Employee As form instructs
x x   Time limits Flexible Spending: Permitted Election Change Form Employee Human Resources
      x Family Partner Designation form
Sick leave, bereavement leave, FMLA and dental insurance
Employee Human Resources
      x Declaration of Domestic Partnership
Health insurance
Employee ETF
      x Termination of Domestic Partnership
Health insurance
Employee ETF

Family status change may include Marriage, Divorce, Creation or Termination of Domestic Partnership, Birth of Child, Adoption of Child, Pre-Adoption Placement of Child, Start of Guardianship of Child, Death of Family Member, or Dependent No Longer Eligible for Coverage Due to Age.

Beneficiary Change: A divorce, annulment, or similar event will NOT invalidate a Beneficiary Designation which named a former spouse or domestic partner. To remove a former spouse or domestic partner as beneficiary, the employee must file a new designation form. If a minor child is listed as a beneficiary, the benefit will not be distributed until a court-appointed guardian has been named. That guardian will be given limited discretion to manage the benefit proceeds.

Central Payroll is located in Room 414 of the City-County Building, 210 Martin Luther King, Jr. Blvd.

Time Limits for Qualifying Events

There are time limits for form submittal due to family status changes. In order to make changes to insurance or other benefits, you must declare the change in family status by the required date.

30-day application requirement

The following family status changes have a 30 day application requirement for ETF (Health and Retirement).​

May not be an exhaustive list.

  • Marriage
  • Creation of domestic partnership
  • Loss of eligibility for other medical coverage or employer contribution for other coverage
  • Legal guardianship granted
  • Dependent loss of eligibility for other coverage
  • Child age 26 or older becomes disabled
  • Return to work after leave or layoff (with coverage lapse due to nonpayment of premiums)

31-day application requirement

The following changes to life Insurance coverage must be made within 31 days of a family status change:

  • Initial enrollment
  • Increase level of coverage
  • Add dependent coverage
  • Increase existing dependent coverage

An increase in life insurance coverage by one level, or addition of dependent unit(s) of coverage may be made within 31 days following the qualifying event that is the basis for the change. A request to increase life insurance coverage by more than one level, or to increase life insurance coverage or add dependent unit(s) of coverage outside of 31 days following a qualifying event, requires an Evidence of Insurability application.

60-day application requirement

The following family status changes have a 60 day application requirement for ETF (Health and Retirement).​

May not be an exhaustive list.

  • Birth of a child, adoption of a child, or placement of a child for adoption
  • Single mother/father declaring parentage and changing to Family coverage (date of birth start)
  • National Medical Support Notice (see ETF information)

Open Enrollment Health Coverage Changes

In the absence of a qualifying event, the following family status changes to Health Coverage may only be made during Open Enrollment in the fall.

May not be an exhaustive list.

  • Add or drop coverage for employee and/or adult dependent children
  • Spouse/domestic partner to spouse/domestic partner transfer of health insurance coverage

The following family status changes to Health coverage are the employee’s responsibility to report and must be timely in relation to the event.

May not be an exhaustive list.

  • Divorce
  • Child’s change in eligibility
  • Employee obtains or loses other health insurance, including Medicare
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