Health & Dental Insurance
In 2019, the City of Madison is participating in ETF Program Option 14: Local Deductible Plan without Dental. City of Madison employees will not have access to ETF’s Uniform Dental Benefits.
Looking for information on 2020 plan year benefits? Please visit the Open Enrollment page at https://www.cityofmadison.com/human-resources/benefits/open-enrollment.
The City of Madison offers employees the choice of any plan offered through Employee Trust Funds’ Wisconsin Public Employer Group Health Insurance Program Option 14, including three health maintenance organizations (HMO) offering networks in the Dane County service area. Employees may sign up for health insurance upon starting employment with the City, during the annual open enrollment period, or within a specified amount of time following a qualifying event (family status change, loss of other coverage, etc.).
Current employees may not enroll or make changes to coverage outside of the open enrollment period unless they have experienced a qualifying event, such as a change of family status. Please note that there are time limits for making changes following a qualifying event. Please make changes online, or submit a Health Insurance Change Form to Human Resources.
All available health plans under the Program have annual medical deductibles of $500 for Single (employee-only) plans or $1,000 for Family (employee plus dependent(s)) plans. For non-preventive care (related to injury or illness, diagnostic in nature, etc.), the cost of care is subject to the annual medical deductible and must be paid by the employee until the annual medical deductible has been met. The employee's health plan will begin paying for the cost of non-preventive covered care after the annual medical deductible has been met. Preventive care is not subject to the annual medical deductible. The City offers eligible employees the option to enroll in a Flexible Spending Arrangement (FSA) to help pay for out-of-pocket healthcare expenses. Additionally, health plans offer interest-free payment plans for qualified members - see https://www.myalex.com/etf/mmyp#financing for more information on requesting a payment plan for healthcare expenses.
Employee premium contributions are deducted from the first paycheck of each month for the following month's coverage.
These monthly premium contributions for 2019 apply to all full-time employees except Compensation Groups 11, 12, 13, 14, 41, and 42. Expanded rate sheets showing contribution amounts for less-than-full-time employees and for employee in Compensation Groups 11, 12, 13, 14, 41, and 42 may be found below.
|Plan Provider||Family Plan||Single Plan|
|Dean Health Insurance||$198.92||$81.05|
|Group Health Cooperative||$201.92||$82.25|
|Quartz - UW Health||$143.02||$58.69|
|Quartz - Community||$432.92||$174.65|
Expanded Premium Rate Charts
Prescription drug insurance is provided through Navitus Health Solutions. Employees who enroll in health insurance coverage are automatically enrolled in Navitus and will be issued a separate Navitus member card.
- How Much Are My Prescription Drugs?, ETF
- Pharmacy Benefit Manager, ETF
- Video: Saving on Your Prescriptions, ETF
The Well Wisconsin incentive, administered by StayWell, is the uniform wellness incentive available to employees and their spouses currently enrolled in the Wisconsin Public Employers Group Health Insurance Program. City of Madison employees and spouses of City of Madison employees who are enrolled in the City's group health insurance program are each eligible for a $150 wellness incentive upon completion of a health risk assessment, health screening, and well-being activity.
As announced in November 2018, the City has developed a gender reassignment benefit in response to Employee Trust Funds' February 2017 action to reinstitute the exclusion for gender reassignment benefits under the group health insurance program.
Eligible employees who themselves or whose eligible dependents incurred and paid out-of-pocket costs related to eligible gender reassignment benefits during calendar year 2018 (Jan. 1, 2018 - Dec. 31, 2018) may request reimbursement of those costs by submitting a claim form, along with supporting documentation, to the benefit's third party administrator, Total Administrative Services Corporation (TASC). The final date to submit claims is June 30, 2019. Claims submitted after June 30, 2019 will be ineligible for reimbursement. A Summary Plan Design, detailing eligible expenses, as well as the claim form, may be found below:
For more information, please see the Employee Benefits Handbook.
View information on Preventive Health Services, HealthCare.gov.
The City of Madison offers optional dental insurance. The City does not contribute towards the premium for this benefit. Employees may sign up for dental insurance upon starting employment with the City, during the annual open enrollment period, or within 30 days of experiencing a qualifying event (such as a family status change or a loss of other coverage).
Current employees may not enroll or make changes to dental coverage outside of the annual open enrollment period, except within 30 days following a qualifying event. If you are already enrolled and have a qualifying change of family status, you may add dependents onto your plan. To make changes, please print the Delta Dental Application and submit it to Human Resources.
Note: Hourly employees are not eligible to participate in the Delta Dental Plan.
Premiums are deducted from the second paycheck of each month for the following month's coverage.
|Employee and Child(ren)||$82.89|
|Employee and Spouse*||$82.21|
Employee, Spouse, and Child(ren)*
*Due to a legislative change, domestic partners of City employees will not be eligible to participate in the dental program beyond December 31, 2017.
The insurance plan offers three (3) different levels of benefits, depending on whether people covered by the plan see a Preferred dentist, a Premier dentist, or a non-participating provider. Benefit levels are highest when seeing a Preferred dentist and lowest when seeing a non-participating provider. Visit Delta Dental WI to view providers in the area.
Vision Care Discount
The Delta Dental plan includes a vision care discount program through EyeMed Vision Care. This is a discount plan, not insurance, that provides savings on exams, glasses, contact lenses and laser vision correction. View providers in the area, or learn more about the Vision Care Discount.