Changes to Employee Information

Employee 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 the change.

Employee information may also be changed in 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.

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

Benefit Information

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

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Task/Form	Completed By	Submit To
Personnel Action	Payroll Clerk or Human Resources	Central Payroll
W-4	Employee	Central Payroll
Wisconsin Withholding Agreement	Employee	Central Payroll
WRS Beneficiary Designation, Complex Designation Form	Employee	ETF
ETF (Health insurance) and/or WRS Address/Name/Gender Change Form	Employee	Human Resources
Health Insurance Application (ETF Instructions)	Employee	Human Resources or ETF
Dental Enrollment/Change/Waiver: English/Spanish	Employee	Human Resources
Vision Enrollment/Change/Waiver: English/Spanish	Employee	Human Resources
Life Insurance Enrollment Change Form	Employee	Human Resources
Disability Insurance Enrollment/Change Form	Employee	Human Resources
Deferred Compensation: Fidelity \| ICMA-RC	Employee	Online or as form instructs
Flexible Spending: Permitted Election Change Form	Employee	Human Resources
Family Partner Designation Form	Employee	Human Resources

Please note that many systems, including payroll and health/retirement, only accept binary “male” and “female” gender/sex options. The City continues to advocate for improvements to these systems. See the Gender-Inclusive Workplace Resource Guide for more information.

Task/Form	Completed By	Submit To
Self-Identification Form	Employee	Human Resources
ETF (Health insurance) and/or WRS Address/Name/Gender Change Form	Employee	Human Resources
Dental Enrollment/Change/Waiver: English/Spanish	Employee	Human Resources
Vision Enrollment/Change/Waiver: English/Spanish	Employee	Human Resources

Task/Form	Completed By	Submit To
Personnel Action in ESS	Employee	Central Payroll via ESS
ETF (Health insurance) and/or WRS Address/Name/Gender Change Form	Employee	Human Resources
Dental Enrollment/Change/Waiver: English/Spanish	Employee	Human Resources
Vision Enrollment/Change/Waiver: English/Spanish	Employee	Human Resources
Deferred Compensation: Fidelity \| ICMA-RC	Employee	Online or as form instructs
Flexible Spending: Permitted Election Change Form	Employee	Human Resources
Family Partner Designation Form	Employee	Human Resources

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.

Task/Form	Completed By	Submit To
WRS Beneficiary Designation, Complex Designation Form	Employee	ETF
Life Insurance Enrollment Change Form	Employee	Human Resources
Disability Insurance Enrollment/Change Form	Employee	Human Resources
Deferred Compensation: Fidelity \| ICMA-RC	Employee	Online or as form instructs

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.

Task/Form	Stipulation	Completed By	Submit To
Family Partner Designation Form	Required	Employee	Human Resources
W-4	May be needed	Employee	Central Payroll
Wisconsin Withholding Agreement	May be needed	Employee	Central Payroll
WRS Beneficiary Designation, Complex Designation Form	May be needed	Employee	ETF
Health Insurance Application (ETF Instructions)	Time Limits Apply	Employee	Human Resources or ETF
Dental Enrollment/Change/Waiver: English/Spanish	Time Limits Apply	Employee	Human Resources
Vision Enrollment/Change/Waiver: English/Spanish	Time Limits Apply	Employee	Human Resources
Life Insurance Enrollment Change Form	Time Limits Apply	Employee	Human Resources
Disability Insurance Enrollment/Change Form	May be needed	Employee	Human Resources
Deferred Compensation: Fidelity \| ICMA-RC	May be needed	Employee	Online or as form instructs
Flexible Spending: Permitted Election Change Form	Time Limits Apply	Employee	Human Resources

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

Changes to Employee Information

Employee Information

Benefit Information

Time Limits for Qualifying Events

30-day application requirement

31-day application requirement

60-day application requirement

Open Enrollment Health Coverage Changes

Pay & Benefits

EmployeeNet

Most Requested

Agency Intranets

Accounts

Crystal Reports

Email: Outlook Web Access

Employee Self Service

Sharepoint Collaborative Sites

Changes to Employee Information

Employee Information

Benefit Information

Name Change

Gender Change

Address Change

Beneficiary Change

Family Status Change

Open Enrollment Health Coverage Changes

Pay & Benefits

EmployeeNet

Most Requested

Agency Intranets

Accounts

Crystal Reports

Email: Outlook Web Access

Employee Self Service

Sharepoint Collaborative Sites