Open Enrollment
THIS PAGE CONTAINS INFORMATION ON OPEN ENROLLMENT FOR HEALTH INSURANCE, DENTAL INSURANCE, VISION INSURANCE, PET INSURANCE, AND FLEXIBLE SPENDING
2022 PLAN YEAR OPEN ENROLLMENT FOR FLEXIBLE SPENDING IS NOVEMBER 1, 2021 - NOVEMBER 19, 2021
2022 PLAN YEAR OPEN ENROLLMENT FOR HEALTH, DENTAL, AND VISION INSURANCE WAS SEPTEMBER 27, 2021 - OCTOBER 22, 2021
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.
Please submit open enrollment requests online, using myETF Benefits for health insurance requests and Employee Self Service (ESS) for dental insurance, vision insurance, and flexible spending enrollments.
Flexible Spending
Flexible Spending Open Enrollment for the 2022 plan year is November 1, 2021 – November 19, 2021.
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 2022 plan year in electronic format by email from Human Resources and/or as paper packets distributed by their departments beginning on November 1, 2021.
- Open Enrollment Memo
- Instructions for enrolling through Employee Self Service (ESS)
- Healthcare Flexible Spending Account Eligible Expenses
- Dependent Care Flexible Spending Account Eligible Expenses
- HIPAA Privacy Notice
- Open Enrollment Packet (Memo, Eligible Expense Lists)
- Change of Election Form
Health Insurance, Dental Insurance, Vision Insurance
Health, Dental, and Vision Insurance Open Enrollment for the 2022 plan year is September 27, 2021 – October 22, 2021. 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, 2022.
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 27, 2021 for each of the benefits for which they are eligible for the 2022 plan year.
Health Insurance - "It's Your Choice"
- 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) during business hours (Monday-Friday, 8:00 am-4:30 pm); 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 - if using the drop box, please place your form inside an envelope addressed to City Human Resources MMB Ste 261. - ETF - It's Your Choice 2022
- ETF - It's Your Choice 2022 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.
2022 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 2022 coverage will be deducted from the 12/10/2021 paycheck.
Rates for Full-time Employees
Expanded rate sheets with prorated contribution amounts for Less-than-full-time Employees:
- General Employees, Police, and Fire (All Compensation Groups Except 41 and 42)
- Metro Transit (Compensation Groups 41 and 42 Only)
Dental Insurance
- Memo: Delta Dental Insurance Enrollment, Including Rates
- 2022 Dental Insurance Coverage Summary
- Instructions for Submitting Dental Insurance Open Enrollment Requests through Employee Self Service (ESS)
- Delta Dental Application (Please Do Not Use if You Have Access to Employee Self Service) This form may be printed and submitted to Human Resources (215 Martin Luther King Jr Blvd Ste 261, Madison, WI 53703) during regular business hours (Monday-Friday, 8:00 am - 4:00 pm); 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 - if using the drop box, please place your form inside an envelope addressed to City Human Resources MMB Ste 261.
- Search for a Delta Dental in-network provider
Vision Insurance
- Memo: DeltaVision Insurance Enrollment, Including Rates
- 2022 Vision Insurance Coverage Summary
- Instructions for Submitting Vision Insurance Open Enrollment Requests through Employee Self Service (ESS)
- DeltaVision Application (Please Do Not Use if You Have Access to Employee Self Service) This form may be printed and submitted to Human Resources (215 Martin Luther King Jr Blvd Ste 261, Madison, WI 53703) during regular business hours (Monday-Friday, 8:00 am - 4:00 pm); 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 - if using the drop box, please place your form inside an envelope addressed to City Human Resources MMB Ste 261.
- Search for a DeltaVision in-network provider
Pet Insurance
- Memo: My Pet Protection pet insurance from Nationwide
- 2022 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.