THIS PAGE CONTAINS INFORMATION ON OPEN ENROLLMENT FOR HEALTH INSURANCE, DENTAL INSURANCE, VISION INSURANCE, PET INSURANCE, AND FLEXIBLE SPENDING

Each year, typically in October and/or November, employees will have the opportunity to participate in open enrollment for health insurance, dental insurance, vision insurance, and flexible spending. Changes made during open enrollment are effective January 1st of the following year. Pet Insurance has year-round open enrollment.

To save paper, we encourage employees to use this site for reference rather than printing this material. Enrollment forms are the only items that need to be printed and returned to Human Resources.

Flexible Spending

Flexible Spending Open Enrollment for the 2021 plan year is October 26, 2020 – November 6, 2020.

To continue participation in Flexible Spending, a new enrollment form must be completed each year.

Eligible employees will receive Flexible Spending Open Enrollment materials for the 2021 plan year in electronic format by email from Human Resources and/or as paper packets distributed by their departments beginning on October 26, 2020.

• Open Enrollment Memo
• Enrollment Form
• Change of Election Form
• Healthcare Flexible Spending Account Eligible Expenses
• Dependent Care Flexible Spending Account Eligible Expenses
• HIPAA Privacy Notice
• Open Enrollment Packet (Memo, Enrollment Form, Eligible Expense Lists)

Health Insurance, Dental Insurance, Vision Insurance

Health, Dental, and Vision Insurance Open Enrollment for the 2021 calendar year is September 28, 2020 – October 23, 2020. During this time, employees may enroll in health insurance, dental insurance, and/or vision insurance for the upcoming plan year, change health insurance carriers, change coverage levels, add or remove eligible dependents, or cancel coverage. Open Enrollment changes for these benefits take effect January 1, 2021.

Eligible employees will receive Open Enrollment materials in electronic format by email from Human Resources and/or as paper packets distributed by their departments beginning on September 28, 2020 for each of the benefits for which they are eligible for the 2021 plan year.

Health Insurance - "It's Your Choice"

Change coverage online

• Memo: It's Your Choice Open Enrollment for Health Insurance
• Health Insurance Application/Change Form
  You do not need to complete this paper application if you have submitted an online change request. If necessary, paper Health Insurance Application/Change Forms may be printed and submitted to Human Resources (215 Martin Luther King Jr Blvd Ste 261, Madison, WI  53703) by inter-departmental mail or USPS, faxed to 608-267-1115, or placed in the drop box located outside the Doty Street entrance to the Madison Municipal Building (due to the COVID-19 pandemic, the Human Resources office is only accessible by appointment) - if using the drop box, please place your form inside an envelope addressed to City Human Resources MMB Ste 261. The form may also be submitted electronically to Human Resources at benefits@cityofmadison.com - please encrypt your message (encrypt an email message and attachments sent from a City email account by typing #secure in the Subject line of your email message).
• ETF - It's Your Choice 2021
• ETF - It's Your Choice 2021 Decision Guide
• ETF - It's Your Choice Member Education - Health Insurance
• ETF - Health Plan Search (includes provider directories for available plans)
• ETF - Vaccinations available at in-network pharmacies at no cost. Click for more information.

2021 Health Insurance Premium Rates

Employee contributions to health insurance premiums are deducted from the first paycheck of each month, for the following month's coverage. For example: The employee contribution to the premium for January 2021 coverage will be deducted from the 12/11/2020 paycheck.
 

Rates for Full-time Employees

Expanded rate sheets with prorated contribution amounts for Less-than-full-time Employees:
Please note that there were errors on the expanded rate sheets that were printed and distributed with WRS-eligible less-than-full-time and hourly General Municipal (All Compensation Groups except 11, 12, 13, 14, 41 and 42) employees' paper packets. The errors have been corrected on the expanded rate sheets posted below. The errors affected the "City Cost" and "Employee Cost" for the 75, 70, and 65 Benefit FTE% rows under each of the Family Carriers.

• General Employees
• Police, Fire and Transit
  Compensation Groups 11, 12, 13, 14, 41 and 42

Dental Insurance

• Memo: Delta Dental Insurance Enrollment, Including Rates
• 2021 Dental Insurance Coverage Summary
• Delta Dental Application
  This form may be printed and submitted to Human Resources (215 Martin Luther King Jr Blvd Ste 261, Madison, WI  53703) by inter-departmental mail or USPS, faxed to 608-267-1115, or placed in the drop box located outside the Doty Street entrance to the Madison Municipal Building (due to the COVID-19 pandemic, the Human Resources office is only accessible by appointment) - if using the drop box, please place your form inside an envelope addressed to City Human Resources MMB Ste 261. The form may also be submitted electronically to Human Resources at benefits@cityofmadison.com - please encrypt your message (encrypt an email message and attachments sent from a City email account by typing #secure in the Subject line of your email message).
• Search for a Delta Dental in-network provider

Vision Insurance

• Memo: DeltaVision Insurance Enrollment, Including Rates
• 2021 Vision Insurance Coverage Summary
• DeltaVision Application
  This form may be printed and submitted to Human Resources (215 Martin Luther King Jr Blvd Ste 261, Madison, WI  53703) by inter-departmental mail or USPS, faxed to 608-267-1115, or placed in the drop box located outside the Doty Street entrance to the Madison Municipal Building (due to the COVID-19 pandemic, the Human Resources office is only accessible by appointment) - if using the drop box, please place your form inside an envelope addressed to City Human Resources MMB Ste 261. The form may also be submitted electronically to Human Resources at benefits@cityofmadison.com - please encrypt your message (encrypt an email message and attachments sent from a City email account by typing #secure in the Subject line of your email message).
• Search for a DeltaVision in-network provider

Pet Insurance

• Memo: My Pet Protection pet insurance from Nationwide
• 2021 Pet Insurance Coverage Summary
• Learn more about pet insurance and get a fast, no-obligation quote. Please note that premiums for Pet Insurance are unable to be paid through payroll deduction. Nationwide will directly bill eligible employees who enroll in this coverage. Open enrollment for Pet Insurance is year-round.
• If you have questions about pet insurance, please contact Nationwide at 877-738-7874.