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Retiree Benefits Open Enrollment Guide 2022-2023

Open Enrollment is a time where you can make changes to your health and dental insurance. Open Enrollment is always between October 15 and November 15. Any changes made during that timeframe are effective as of the following January 1st.

The purpose of this guide is to provide you with the necessary information regarding your benefits through the Madison Metropolitan School District and options for your election changes during Open Enrollment. In this guide, you will find a general overview of plan designs, premiums, and directions on how to make changes during Open Enrollment and required legal notices. Specific information about benefits can be found online at https://www.madison.k12.wi.us/human-resources/employee-benefits

Please note: The information in this guide is not intended to advise you on which particular benefits are appropriate for you and your family. Additionally, all plan documents, laws and regulations supersede information shared in this guide.

Contact Information

HR Department
(608) 663-1693

Benefits Division
(608) 663-1692 benefits@madison.k12.wi.us

Open Enrollment

Open enrollment for the 2022-23 school year is October 15, 2022 – November 15, 2022. Any changes and elections made during open enrollment will be effective January 1, 2023.

The open enrollment period is considered a passive enrollment. This means if you are not making any changes to your benefits, you do not need to do anything. However, if you do wish to make changes to your benefits, you do need to submit your enrollment/change forms to the Benefits Division.

What do I need to do?

  • If you are not making any changes to your current benefits, you do not need to do anything. Your current elections will roll into 2023.

  • If you wish to make changes to your benefits, please complete the following steps.

    Step 1: Gather you and your dependents’ information. This will include:

    • complete names

    • dates of birth

    • social security numbers
       

    Step 2: Complete the applicable enrollment/change forms at the end of this guide.

    Step 3: Review your elections/forms, complete and return no later than November 15, 2022. Return forms to: Benefits Division - Doyle Building, 545 West Dayton Street, Madison, WI 53703

    Step 4: Elections will be processed and sent to the insurance carriers in early December for a January 1, 2023, effective date. Insurance cards will be mailed to your home prior to January 1, 2023.

QUESTIONS? Contact the Benefits Helpdesk at (608) 663-1692 or at benefits@madison.k12.wi.us

General Plan Information

Plan Year

The Madison Metropolitan School District benefits plan year is January 1 through December 31. This guide outlines the benefits available during this identified plan year.

Annual Deductible Year

The annual deductible for all Madison Metropolitan School District benefit plans is January 1 through December 31. The annual deductible resets each year on January 1.

Dependent Coverage

In addition to covering yourself, you can elect to cover your eligible dependents. Your eligible dependents include:

  • Your spouse

  • Your child(ren) through the year in which they turn 26

  • Your child of any age who is not self-supporting due to a mental and/or physical disability

Waive Option

You have the option of not participating in the insurance plans available to you. If you do not enroll in the health insurance plan offered, please indicate you are waiving coverage and your reason. If you waive the health insurance, you are still eligible to enroll in the other benefit options.

Making Changes To Your Benefits

The Internal Revenue Service (IRS) states that eligible employees may only make elections to the plan once a year; annual open enrollment benefit choices are binding through December 31, 2023.

Qualifying life events allow you to make plan changes at any time during the year in which they occur. For any allowable changes, you must enroll online within 30 calendar days of the event (60 days for the birth of a child, CHIP/ Medicaid eligibility or loss of eligibility) to avoid a lapse in coverage. The following include reasons you may change your benefits during the year.

  • Marriage;
  • Birth, adoption or placement of a child for adoption;
  • Divorce or legal separation;
  • Termination or commencement of your spouse’s coverage;
  • Death of spouse or dependent.
  • When a dependent satisfies or ceases to satisfy eligibility requirements.
  • Eligibility (or loss of eligibility) for Children’s Health Insurance Plan (CHIP) or Medicaid; or
  • Eligibility for a special enrollment or annual enrollment in Health Insurance Marketplace (“Exchange”) coverage (to avoid a period of duplicate coverage or no coverage).

Online Information

Comprehensive information about MMSD’s benefits is available online!

  1. Find benefit information on line at MMSD’s Benefits Website (https://www.madison.k12.wi.us/human-resources/employee-benefits)

  2. There’s an app for that! Scan the QR code below or go to mmsd-benefits.com on your mobile device.

HR Benefits App QR Code

Health Insurance

Carriers

You have the opportunity to enroll in health insurance through Dean Health Plan or Group Health Cooperative of South Central Wisconsin. These carriers provide you with a diverse range of networks and providers, yet have the exact same type of coverage (copays, etc.). They do have slightly different employee premiums (what you pay per pay period for your coverage).

Plan Options

Each carrier provides a Health Maintenance Plan (HMO), Point-of-Service Plan (POS) or Preferred Provider Organization Plan (PPO). The PPO plan is only available to employees who do not live in South Central Wisconsin.

The HMO plan allows you to use in-network providers only. GHC uses GHC Clinics, UW Hospital and Meriter Hospital. Dean Health Plan uses SSM Health/Dean Clinics and SSM Hospital for Dean. If you need to see an out-of-network provider, such as provider at Mayo Clinic or a specialty care provider, your doctor will request a referral to these providers. The referral will be approved if there are no in-network providers that can treat the condition. The HMO plans have an annual deductible of $100 per person ($200 per family). The annual deductible resents every January 1. They have $20 office visit copays (this does not apply to preventive care visits and visits for children age 18 and younger). They also have a $150 emergency room copay.

Under the POS plan, you have the option to use in-network providers, but you are also able to use out-of-network providers without pre-approval or a referral. With out-of- network providers, you have an additional $250 individual annual deductible ($500/family) and an 80/20 co-insurance cost -- you pay the first $250/$500 of services and then 20% of the costs once the annual deductible has been met.

Child on Trampoline

Some employees elect the POS plan for the flexibility to see out-of-network providers, even if it may never happen. As a reminder, if you needed a referral to an out-of-network provider due to a medical condition that an in-network provider cannot treat, you can request a referral to a specialist that can treat that condition, although it is not guaranteed to be approved. Other employees have selected the POS plan due to dependents who live outside of the area, such as college students, or due to significant family travel needs. The HMO plan covers urgent care and emergency care anywhere within the USA. If you or a family member needs urgent or emergency care, the HMO plan will cover those costs as if it was in network. By enrolling the POS plan and not using out- of-network providers, you are incurring additional costs (higher premiums out of your paycheck and district resources) and you may be enrolled in a plan that doesn’t meet your medical needs.

There are circumstances where the POS plan may be the best plan to be enrolled in. That’s ok, you can enroll in the POS plan. But, be mindful that the premium contribution difference between the HMO and POS plan may be more than what it would cost you to pay for the out-of-network medical care out of your pocket.

Plan Overview

Dean Health Plan

  HMO POS and PPO
In-Network In-Network Out-of-Network
Deductible* $100 per member
$200 family max		 $100 per member
$200 family max		 $250 single
$500 family
Coinsurance 0% 0% 20% after deductible
Maximum Out-of-Network Out-of-Pocket $7,150 single
$14,300 family		 $7,150 single
$14,300 family		 $14,350 single
$28,600 family
Office Visit** $20 $20 20% after deductible
Preventive Care*** 100% covered 100% covered 20% after deductible
Vision Exam $20 $20 Not Covered
Chiropractor $20 $20 20% after deductible
Therapy (PT/OT/ST) 0% after deductible 0% after deductible 20% after deductible
Hospital (In-Patient) No charge after Deductible No charge after Deductible 20% after deductible
Hospital (Out-Patient) No charge after Deductible No charge after Deductible 20% after deductible
Emergency Department $150 $150 $150
Urgent Care $20 $20 $20
Prescriptions $6, $15, $30 $6, $15, $30 Not covered

Group Health Cooperative

  HMO POS and PPO
In-Network In-Network Out-of-Network
Deductible* $100 per member
$200 family max		 $100 per member
$200 family max		 $250 single
$500 family
Coinsurance 0% 0% 20% after deductible
Maximum Out-of-Network Out-of-Pocket $6,600 single
$13,200 family		 $6,600 single
$13,200 family		 $1,250 single
$2,500 family
Office Visit** $20 $20 20% after deductible
Preventive Care*** 100% covered 100% covered 20% after deductible
Vision Exam $20 $20 20% after deductible
Chiropractor $20 $20 20% after deductible
Therapy (PT/OT/ST) 0% after deductible 0% after deductible 20% after deductible
Hospital (In-Patient) No charge after Deductible No charge after Deductible 20% after deductible
Hospital (Out-Patient) No charge after Deductible No charge after Deductible 20% after deductible
Emergency Department $150 $150 $150
Urgent Care $20 $20 $20
Prescriptions $6, $15, $30 $6, $15, $30 Not covered

*Annual Deductibles reset each January 1
**Labs are subject to deductible and coinsurance
***Preventive care is defined by the federal guidelines

While every effort is made to illustrate the carriers'; various benefits, discrepancies or errors are possible. In the event of an error, the actual product brochure furnished by the insurance carrier and approved by the Commissioner of Insurance will prevail. The master contract and policyholder certificates are more detailed and should be used for the determination of benefits. All plans will comply with state and/or federal requirements regarding nervous and mental benefits.

Additional Benefits

Listed below are some of the programs in place to help you utilize all of the benefits available through the health insurance plan. Wellness benefits are provided through both Dean and GHC.

  • Dean’s Living Healthy program allows you to earn up to $150 in wellness rewards ($100 for covered spouses and adult children 18 & older) for completing a heath assessment, having a MyChart account, and more! More information can be found at: https://www.deancare.com/wellness/health-and-wellness

  • GHC’s ManageWell rewards program provides you and your family an opportunity to earn points on a quarterly basis. Visit https://ghcscw.com/wellness/wellness-reimbursement for details.

  • GHC Care OnDemand provides 24/7/365 virtual access to providers and therapists.

  • My Chart and mobile phone applications are provided to access your benefit and claim information.

Health Insurance Monthly Premiums

Dean

  HMO POS PPO
Single $717.02 $800.02 $1,087.09
Family $1,885.76 $2,104.05 $2,859.05

GHC

  HMO POS PPO
Single $608.68 $883.83 $980.24
Family $1,627.84 $2,359.84 $2,617.27
two students stretching

Dental Insurance

Dental Coverage

Delta Dental of Wisconsin is the Dental Insurance carrier. Delta Dental has a nation-wide network, and covers more than 75% of the area and nation’s dentists. Your lowest out-of-pocket costs will come from seeing a Delta Dental PPO dentist, but you will also receive cost advantages if you see a Premier dentist. Dental expenses are all eligible expenses for Health Care Flexible Spending.

Basic Coverage
Plan Overview and Premiums

Plan Overview

Annual Maximum $1,200 per person
Deductible $25
Preventive Services (not subject to deductible)
Cleanings 100%
Examinations 100%
Bitewings 100%
Sealants 100%
Basic Services
Periodontics 80%
Endodontics 80%
Fillings 80%
Oral Surgery 80%
Extractions 80%
Root Canals 80%
Major Services
Crowns 50%
Bridges 50%
Implants 50%
Dentures 50%
Orthodontia
Orthodontia 100%
Lifetime Maximum $2,000 per person

Premiums

Retiree: Escrow/HRA Paid
Single $43.75
Family $114.83
Retiree: Direct Bill with Delta
Single $45.89
Family $114.83
smiling student with braces

Additional Contact Information

Madison Metropolitan School District
Address: 545 West Dayton Street, Madison, WI 53704
Telephone: 608-663-1692 (Benefits Helpdesk)
Website: https://www.madison.k12.wi.us/human-resources/
Benefits Helpdesk: benefits@madison.k12.wi.us

Compliance Guide:

Compliance Addendum

Dean Health Plan (Health Insurance)
Telephone: 800-279-1301
Website: https://www.deancare.com/

Group Health Cooperative (Health Insurance)
Telephone: 800-605-4327
Website: https://www.ghcscw.com/

Delta Dental of Wisconsin (Dental Insurance)
Telephone: 800-236-3712
Website: https://www.deltadentalwi.com/s/

UNUM (Long Term Care Insurance)
Telephone: 866-679-3054
Website: https://www.unum.com/

Wisconsin Retirement System (Pension)
Telephone: 877-533-5020
Website: https://etf.wi.gov/retirement