Alyssa Lane
If you're a resident of Madison, Wisconsin, and are looking to apply for medical insurance, there are a few options available to you. The City of Madison offers its employees a range of health insurance plans, including three health maintenance organizations (HMOs) with networks in the Dane County service area: Dean Health Plan, Group Health Cooperative (GHC), and Quartz - UW Health. Additionally, the city provides optional vision insurance through Delta Vision's Select Network and a standalone dental insurance plan through Delta Dental of Wisconsin. If you're not eligible for these plans or are looking for alternative options, you can explore private health insurance providers such as WPS Health Insurance or look into Medicare options available in Wisconsin. It's important to have health insurance to ensure easier access to healthcare services and avoid large medical bills.
| Characteristics | Values |
|---|---|
| City of Madison, WI, health insurance | 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.) |
| Dental insurance | The City of Madison offers Delta Dental insurance with two levels of benefits depending on whether the covered person sees a Preferred or Premier dentist, or a non-participating provider. |
| Vision insurance | The City of Madison offers optional vision insurance through Delta Vision's Select Network. |
| Medicare | WPS Health Insurance provides Medicare supplement insurance. |
| Flexible spending | The City offers eligible employees the option to enroll in a Flexible Spending Account (FSA) to help pay for out-of-pocket healthcare expenses. |
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What You'll Learn
City of Madison health insurance options
The City of Madison offers its employees a range of health insurance options. Firstly, it is important to note that health insurance coverage can be obtained upon starting employment with the City of Madison, during the annual open enrollment period, or within a specified amount of time following a qualifying event (such as a family status change or loss of other coverage).
The City of Madison offers its employees the choice of any plan through ETF's Wisconsin Public Employer Group Health Insurance PO 14. This includes three health maintenance organizations (HMOs) with networks in the Dane County service area: Dean Health Plan, Group Health Cooperative (GHC) of South Central Wisconsin - Dane Choice, and Quartz - UW Health.
In addition, the City of Madison provides prescription drug insurance through Navitus Health Solutions. Employees who enroll in health insurance are automatically enrolled in Navitus and receive a separate Navitus member card. The City also offers optional dental insurance through Delta Dental, with three levels of benefits depending on whether a preferred, premier, or non-participating dentist is chosen. The City does not contribute to the premium for this benefit.
Vision insurance is also offered by the City of Madison through Delta Vision's Select Network. This benefit is also optional, and the City does not contribute to the premium. The City also offers a standalone vision insurance benefit, and Delta Dental of Wisconsin partners with Amplifon USA to provide a discount program for savings on hearing aids and services.
The City of Madison also offers eligible employees the option to enroll in a Flexible Spending Account (FSA) to assist with out-of-pocket healthcare expenses. Furthermore, health plans offer interest-free payment plans for qualified members.
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Annual open enrollment period
The City of Madison offers its employees a range of health insurance options, including three health maintenance organizations (HMOs) with 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 can sign up for health insurance when they start their employment, during the annual open enrollment period, or within a set amount of time after a qualifying event, such as a loss of coverage or a change in family status.
The annual open enrollment period for the City of Madison usually falls between September and November. For example, for the 2025 plan year, the open enrollment period was from September 30 to October 25, 2024. During this time, employees can make changes to their health insurance, such as enrolling in a new plan, changing carriers, adjusting coverage levels, adding or removing dependents, or cancelling coverage without a qualifying event.
To assist employees during the open enrollment period, the City of Madison provides digital Open Enrollment packets and sends courtesy emails to employees, directing them to log in to Employee Self Service (ESS) to view the Open Enrollment Notification. This notification provides relevant information, including details about benefit groups for health, dental, and vision insurance, and links to the Human Resources Open Enrollment webpage.
It is important to note that the annual open enrollment period is the primary opportunity for eligible employees to make changes to their benefit plans for the upcoming calendar year. Outside of this period, changes are typically only allowed in the event of a qualifying life event, such as a change in family or employment status.
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Qualifying events
In the context of health insurance, a qualifying event is a life event that allows you to buy new coverage or change your existing coverage outside of the annual open enrollment period. Here are some examples of qualifying events:
- Loss of health insurance: Losing your health insurance is considered a qualifying event. This includes losing your coverage in the past 60 days or expecting to lose your coverage in the next 60 days.
- Change in family status: Changes in family status, such as marriage, divorce, or having a baby, are considered qualifying events.
- Change in employment status: A change in your employment status, such as starting a new job, losing your job, or changing your work hours, may qualify you for a special enrollment period.
- Moving: If you have recently moved or are planning to move to an area where your current coverage is not available, this could be considered a qualifying event.
- Turning 26: When individuals turn 26, they are no longer eligible to remain on their parents' health insurance plans. Therefore, turning 26 is considered a qualifying event.
- Gaining a dependent: If you gain a dependent through birth, adoption, or legal means, this may qualify you for a special enrollment period.
- Special circumstances: Certain special circumstances, such as becoming a US citizen, gaining membership in a federally recognized tribe, or being affected by a natural disaster, may also be considered qualifying events.
It is important to note that the specific requirements and time limits for qualifying events may vary, and documentation may be required. Therefore, it is always best to check with the relevant health insurance provider or local authorities to confirm the details of qualifying events and the necessary steps to take.
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Dental and vision insurance
The City of Madison offers its employees the option of dental insurance through Delta Dental. The city does not contribute to the premium for this benefit. Employees can sign up for dental insurance when they start working for the city, during the annual open enrollment period, or within 30 days of a qualifying event such as a change in family status. Current employees cannot make changes to their dental coverage outside of the open enrollment period, except within 30 days of a qualifying event.
The Delta Dental plan offers three levels of benefits, depending on whether the dentist is preferred, premier, or non-participating. The benefit levels are highest when seeing a preferred dentist and lowest when seeing a non-participating provider.
The City of Madison also offers optional vision insurance through Delta Vision's Select Network. Similar to the dental insurance, the city does not contribute to the premium for this benefit. Eligible employees can sign up for vision insurance when they join the city, during the annual open enrollment period, or within 30 days of a qualifying event. Current employees can only make changes to their vision coverage during the open enrollment period, except within 30 days of a qualifying event.
Delta Dental of Wisconsin has partnered with EyeMed to provide a vision care discount program. Additionally, they have partnered with Amplifon USA to offer a discount program for savings on hearing aids and services, as well as assistance with locating nearby hearing care providers.
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Medicare supplement insurance
In Wisconsin, there is only one Medigap plan available, with additional options to customise the policy to meet your needs. These include "50% and 25% Cost-sharing Plans", which are similar to standardized Plans K and L, respectively. A high-deductible plan is also available. Wisconsin is one of three states where Medicare supplement plans are standardized differently, offering Base Plans that can be paired with riders for more coverage.
The Health Insurance Store in Madison, WI, offers Medicare Supplement Insurance (Medigap) and Medicare Part C (Medicare Advantage Plans) from various insurance companies. They provide free consultations to help customers understand their options and choose a plan that suits their health needs, budget, and specific doctors they need to access. The company also provides ongoing service and support after enrolment, including assistance with questions or issues and annual health and drug plan reviews.
WPS Health, another provider of Medicare Supplement Insurance (Medigap) in Wisconsin, offers free webinars to explain Medicare and its parts, the pros and cons of different options, and expected changes. They also provide Wisconsin-based support to simplify the enrollment process, handle claims, and answer any questions. WPS agents can help customers find the best Medicare supplement plan for their specific medical and financial needs.
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Frequently asked questions
The City of Madison offers employees a range of health insurance plans, including three health maintenance organizations (HMOs): 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 (usually 30 days) following a qualifying event such as a family status change or loss of other coverage.
Yes, the City of Madison offers optional vision and dental insurance. Vision insurance is provided through Delta Vision's Select Network, while Delta Dental of Wisconsin provides dental insurance.
To apply for dental insurance, you need to print and submit the Delta Dental Application to the Human Resources Department. Please note that hourly employees are not eligible for the Delta Dental Plan.
Having health insurance provides access to healthcare services and helps cover medical expenses. The City of Madison also offers eligible employees the option to enroll in a Flexible Spending Account (FSA) to help pay for out-of-pocket healthcare costs.
