Health Insurance

The District offers health insurance through Dean Health Plan or Quartz. These insurers generally have the same benefit designs (deductible, copays, etc.) but provide a different range of networks and providers and different premiums apply (what you pay per pay period for your coverage).

The plan year for coverage is January 1 through December 31.

Eligibility

Health insurance is available to regular employees who are scheduled to work 19 or more hours per week, or have a contract of at least 50%. Newly hired eligible employees have 30 days from their hire date to enroll in coverage, otherwise employees must wait until the District’s Open Enrollment period to sign-up. Open Enrollment occurs October 15 – November 15 every year.

Employees may select single coverage which covers the employee only or family coverage which covers the employees’ spouse and dependents through the calendar year in which they turn 26 years of age.

Employees may enroll in health insurance during other times of the year, but only if they have a qualifying life event.

Plan Options

Employees have a choice of health plans available through Quartz or Dean Health Plan. The benefit designs (deductible, copays, etc.) are generally the same if you use in-network providers, but each insurer has different in-network providers and different premiums apply.

Both Quartz and Dean provide a Health Maintenance (HMO) plan, a Point-of-Service (POS) Plan and a Preferred Provider Organization (PPO) Plan. The PPO plan is only available to employees or retirees who do not live in South Central Wisconsin.

To view a summary out-of-pocket costs under each plan type, see Health Plan Overview. To view details on what is covered under each plan, see the Summary of Benefits and Plan Certificates in the Plan Document boxes on the right.

HMO Plan
The HMO plan only covers services at in-network providers unless it’s an emergency. Below is a list of the major health care providers that are in-network for Quartz and Dean Health Plan.

Quartz	Dean Health Plan
UW Health	SSM Health/Dean Clinics
GHC Clinics (excluding Urgent Care)	SSM Health - St. Mary’s Hospital
Unity Point Health Meriter Clinics	SSM Health - St. Clare Hospital
UW Hospital and Unity Point Health Meriter Hospital	SSM Health - Janesville

If you see an in-network provider, the plan generally covers all medically necessary services (excluding deductible and copays). Both Dean and Quartz require enrollees in the HMO plan to select a primary care provider at enrollment. Some specialists may require a referral from a primary care provider before seeing a new patient.

Out-of-Area Dependents in the HMO Plan
If you have a dependent under 26 years of age that lives outside of the HMO service area for part of the year, they may see an out-of-network provider for some services, but the services are subject to prior authorization. See the information below or contact Quartz or Dean for more information.

Quartz Out-of-Area Dependent Coverage
Dean Out-of-Area Dependent Coverage

Emergency services are always covered as in-network services and do not require prior authorization.

POS and PPO Plans
The POS and PPO plans provide the most benefit for services provided at in-network providers, but coverage is still available for services received at non-network providers. For the POS and PPO plans, the out-of-network plan design includes a $250 individual/$500 family annual deductible and 20% coinsurance after the deductible has been met.

The monthly premiums for the POS and PPO plans are higher than the HMO plan because of the additional benefits available for services received from non-network providers.

Employees that elect the POS plan might live in South Central Wisconsin, but want the flexibility to see out-of-network providers, especially if they live out of the area for part of the year. Employees that live outside of the service area year-round must enroll in the PPO plan and have access to a nationwide network of providers.

Preventive Services and Emergency Care
Federal law requires that all preventive services are covered 100% under all plans, but only if received at in-network providers. Click here to see a list of qualifying preventive services.

Federal law also requires that emergency care must always be covered as an in-network benefit, even if provided by a non-network provider.

Still confused about HMO vs. POS vs. PPO? See the plan comparisons and service area maps below.

Quartz Plan Comparison
Quartz Service Area Map

Dean HMO & POS Plan Comparison
Dean Service Area Map

Cost

Employees’ premium contribution is a percentage of the total monthly cost of coverage and is taken from paychecks on a pre-tax basis. The difference between the amount employees contribute and the total due to the insurer is paid by the District.

An employee’s premium contribution per pay period reflects the following selections:

Insurer (Quartz or Dean Health Plan),
Plan Type (HMO, POS, or PPO),
Coverage Tier (single or family),
Employee Type (Supportive educational employee, teacher, food service, administrator, etc.), and
Payroll frequency (monthly or biweekly).

Premiums for health insurance are paid one month in advance. For example, the July health insurance premiums are taken from June paycheck(s). Adjustments may be made after enrolling or changing coverage to catch-up on premiums. The insurance premium table on the right shows the total premium and employee contributions for 2024-25. Premiums are subject to change every July (June paychecks).