Health, Dental, and Vision Insurance

Program Option (PO) 14 has uniform benefits, which means all plans have the same deductibles/copays and are subject to ETF's Certificate of Coverage, which outlines minimum essential coverage. A link to the Certificate is provided in the "Health Insurance Resources" section.

A plan may offer more generous benefits than those required by PO 14 if not excluded from coverage by ETF, but in general, there are three primary differences between health plan options. These are:

• Service area(s)
• Covered providers (including hospitals, doctors, clinics, etc.)
• Monthly premiums

All available health plans 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.

Emergency/Urgent Care

Emergency and urgent care are covered out-of-network for all plans, as long as the health plan/primary care provider are contacted within 24 hours following the emergency/urgent care visit. If the plan is not contacted, the member may be responsible for the full cost of care. Follow-up care must be received in-network.

Dental/HDHP

City health insurance does not include dental insurance – our dental insurance is fully separate from health insurance, and is administered directly through Delta Dental. See the "Dental Insurance" section of this webpage for details. 

Our health insurance also does not include the option to elect a High Deductible Health Plan (HDHP).

• Both dental and HDHP are mentioned on the Health Application/Change Form in Section 5; neither of those questions apply to City employees. Checking these boxes in Section 5 will have no impact on health insurance or dental insurance.

Vision

City health insurance plans provide coverage for one (1) annual eye exam per covered individual to diagnose and treat diseases and conditions of the eye. This coverage does not include frames, lenses, contacts, or any other vision-related expenses.

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. To submit changes, please complete and return a Health Application/Change Form to Human Resources. 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.

Effective January 1, 2025, the Department of Employee Trust Funds (ETF) requires 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. If sufficient documentation is not immediately available, we recommend you submit any benefit change form(s) to HR first – as soon as possible after an eligible qualifying event – to ensure you do not miss the deadline. Although documentation can be brought to HR later, please note that in-person document verification still needs to be completed by HR staff no later than the deadline for the qualifying event.

If you believe you will not be able to present sufficient documentation by the qualifying event deadline (for example, if you need to order a new birth certificate and it will arrive after the deadline), you must notify HR at benefits@cityofmadison.com before the deadline and share your expected timeline to have documentation in hand.

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.

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

The monthly employee premium contributions outlined in the table below are for the 2026 Plan Year, and apply to all permanent full-time employees except employees in Compensation Groups 41 and 42. Permanent part-time employees and Metro Transit employees in CG41/CG42 should refer to the ratesheets linked below the table.

• The premiums outlined below are for the most commonly-selected health plan options only. Employees can opt to enroll in any of the health plans offered through ETF.
• Besides the Access Plan (which is the only PPO plan through ETF), there are three HMO health plan options that provide coverage in Dane County. These are Dean Health Plan by Medica, Group Health Cooperative (GHC) of South Central Wisconsin - Dane Choice, and Quartz - UW Health, indicated in bold text in the table below.

If you have experienced a qualifying event, are thinking about enrolling in health insurance or changing health plan providers, and are not sure which to choose, we recommend ETF's 2026 Health Plan Search as a great place to start.

Ratesheets

• Detailed ratesheet for permanent full-time employees: includes information for employees in all Compensation Groups (CGs), including CG41/CG42.
  • Page 2 includes premiums for all health plan options offered through ETF in 2026, and instructions on how to calculate employee premiums for option(s) not broken out into employee/employer splits on page 1.
• Expanded ratesheets for permanent part-time employees:
  • General municipal employees, Police, and Fire (all Compensation Groups except 41 and 42)
  • Metro Transit (Compensation Groups 41 and 42 only)

• ETF 2026 Health Benefits Decision Guide: Please note that only the health and pharmacy benefit information applies to City employees; information about other benefits, including dental/vision, does not apply.
  • For a more detailed breakdown of the items in the coverage summary on page 4 of the Decision Guide, we recommend you review the 2026 Schedule of Benefits for Program Option 14.
  • For the most detailed breakdown of coverage information for all Group Health Insurance Program options through ETF, including for Program Option 14, we recommend you review the 2026 Uniform Benefits Certificate of Coverage.
• ETF's 2026 Health Plan Search: Includes provider directories, summaries, and contact information for all available plans
• ETF Program Option 14: Local Deductible without Dental - 2026 Plan Year: General information for our group health insurance Program Option via ETF
• ETF Video Library: Online benefits forums, on-demand videos, and other recorded or interactive resources from ETF, including resources about the 2026 Plan Year
• ETF's Notice of Privacy Practices
• ETF's Continuation of Coverage Rights (COBRA information)

Navitus Health Solutions is the third-party administrator of ETF's prescription drug program, which negotiates rebates and discounts on behalf of the City’s Group Health Insurance Program. Employees who enroll in health insurance coverage are automatically enrolled in Navitus and will be issued a separate Navitus member card.

To look up coverage for a specific prescription, please go to the Navitus website and select IYC Health Plan-IYC Access Plan State-Local Plan. There is a search function on the website, and you can also download a searchable PDF copy of the most recent pharmacy formulary via the "Formulary" tab.

Resources

• How Much Are My Prescription Drugs?
• Pharmacy Benefit Manager
• Video: Saving on Your Prescriptions
• Pharmacy benefit vaccination information: vaccinations are available at in-network pharmacies at no cost to participants

The City's dental insurance plan offers three (3) different levels of benefits, depending on whether people covered by the plan see a Preferred (PPO) dentist, a Premier dentist, or a non-participating provider. Benefit levels are highest when seeing a PPO dentist and lowest when seeing a non-participating provider.

There is a $1,000 individual annual maximum for covered services. The City also has a plan feature called "CheckUp Plus." With CheckUp Plus, enrollees can get diagnostic and preventive dental services without those costs being applied to the individual annual maximum.

Visit Delta Dental WI to view providers in the area, and see the "Dental Insurance Resources" section of this webpage for a printable coverage summary document.

Vision Care Discount

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; it is available to City employees who are enrolled in dental insurance but not vision insurance through City.

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, and 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.

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.

Premiums are deducted from the second paycheck of each month for the following month's coverage. The City does not contribute to the premium for dental insurance.

• Summary of Dental Benefits (English) | Summary of Dental Benefits (Spanish)
• Smarter Dental Plans
• Finding a Network Dentist
• Online Services for Members
• Delta Dental Informational Presentation (2024)
• Delta Dental Website

There are two levels of coverage for vision insurance through DeltaVision's Select Network: In-Network and Out-of-Network. Standalone vision insurance provides a greater level of coverage for frames, lenses, contacts, and other vision-related expenses than the Vision Care Discount (which is included as a part of City dental insurance). See the Coverage Summary under "Vision Insurance Resources" for a detailed breakdown of coverage.

• If enrolled in City health insurance: City health insurance plans do provide coverage for one (1) annual eye exam per covered individual to diagnose and treat diseases and conditions of the eye. This coverage does not include frames, lenses, contacts, or any other vision-related expenses.

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.

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