Health, Dental, and Vision Insurance

The City of Madison offers employees the choice of any plan offered through ETF's Wisconsin Public Employer Group Health Insurance PO 14, including three health maintenance organizations (HMOs) offering networks in the Dane County service area: Dean Health Plan, Group Health Cooperative (GHC) of South Central Wisconsin - Dane Choice, and Quartz - UW Health.

Employees may sign up for health insurance upon starting employment with the City in a position eligible for health insurance; 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 in, make changes to, or cancel 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 (in most cases, 30 calendar days), and that documentation may be required. Please make changes online (if possible) or submit a Health Insurance Change Form to Human Resources.

Documentation Requirement for Health Insurance

Effective January 1, 2025, the Department of Employee Trust Funds (ETF) will require in-person verification of legal proof of parenthood and/or marriage (e.g. birth certificate, marriage certificate, and/or court order for adoption) for all new enrollments and all enrollments or changes due to midyear qualifying events. This is in addition to existing documentation requirements for other qualifying events and benefits, such as proof of loss of coverage documentation or proof of divorce.

This expanded documentation requirement does not impact qualifying event deadlines to return benefits form(s) to Human Resources. Because of this, HR recommends you still submit any benefit change form(s) to HR as soon as possible following an eligible qualifying event to ensure you do not miss the deadline. Any required documentation can be presented for verification at a later date, as soon as it becomes available to you.

Once your documentation has been verified and ETF gives final approval to your change, health insurance coverage for you and/or your dependent(s) will backdate to the event date unless otherwise advised.

Coverage Information

All available health plans under the Program have annual medical deductibles of $500 for Single plans or $1,000 for Family plans. Single plans cover the employee only; Family plans cover any combination of the employee + spouse and/or dependent(s). 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 Account (FSA) to help pay for out-of-pocket healthcare expenses. Additionally, health plans offer interest-free payment plans for qualified members.

Monthly Premiums

Employee premium contributions are deducted from the first paycheck of each month for the following month's coverage.

These monthly premium contributions for 2025 apply to all permanent full-time employees except employees in Compensation Groups 41 and 42. Expanded rate sheets showing contribution amounts for permanent part-time employees and for employees in Compensation Groups 41 and 42 may be found below.

Compare health plan providers.

Expanded Premium Rate Charts

• General Employees and Protective Service Employees (All Compensation Groups except 41 and 42)
• Metro Transit (Compensation Groups 41 and 42)

Prescription Drugs

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?
• Pharmacy Benefit Manager
• Video: Saving on Your Prescriptions

The City of Madison offers optional dental insurance through Delta Dental. The City does not contribute towards the premium for this benefit. Eligible employees may sign up for dental insurance upon starting employment with the City, during the annual open enrollment period, or within 30 calendar 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 calendar 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. Please note that documentation may be required. To make changes, please print the Delta Dental Application (English), Delta Dental Application (Spanish) and submit to the Human Resources Department.

Hourly employees are not eligible to participate in the Delta Dental Plan.

2025 Monthly Premiums

Premiums are deducted from the second paycheck of each month for the following month's coverage.

*Due to a legislative change, domestic partners of City employees will not be eligible to participate in the dental program beyond December 31, 2017.

Deductible

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.

Summary of Dental Benefits (English) | Summary of Dental Benefits (Spanish)

• Smarter Dental Plans
• Finding a Network Dentist
• Online Services for Members

Vision Care Discount (through group dental plan)

Delta Dental of Wisconsin partners with EyeMed to provide a vision care discount program. 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. The vision care discount may not be combined with other vision insurance coverage. The City also offers a standalone vision insurance benefit.

Hearing Health Care

Delta Dental of Wisconsin partners with Amplifon USA to provide a discount program for savings on hearing aids and services, as well as assistance with locating nearby hearing care providers.
Learn more at Amplifon USA or by calling 1-888-901-0132.

Resources for More Information:

• Employee Benefits Handbook
• Delta Dental Informational Presentation (2024)
• Delta Dental Website

Effective January 1, 2020, the City of Madison offers optional vision insurance through Delta Vision's Select Network. The City does not contribute towards the premium for this benefit. Eligible employees may sign up for vision insurance upon starting employment with the City, during the annual open enrollment period, or within 30 calendar 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 vision coverage outside of the annual open enrollment period, except within 30 calendar 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. Please note that documentation may be required. To make changes, please print the Delta Vision Application (English), Delta Vision Application (Spanish) and submit to the Human Resources department.

Hourly employees are not eligible to participate in the Delta Vision Plan.

2025 Monthly Premiums

Premiums are deducted from the second paycheck of each month for the following month's coverage.

Summary of Vision Benefits (English) | Summary of Vision Benefits (Spanish)

• Finding a Network Vision Provider
• Out-of-Network Vision Services Claim Form

Delta Vision Informational Presentation