Pay & Benefits,Benefits,Health, Dental, Vision Insurance,UW Hospitals and Clinics

Health Insurance (UWHC)

Health Insurance (UWHC) - Pay & Benefits, Benefits, Health, Dental, Vision Insurance, UW Hospitals and Clinics


Benefit Summary

UWHC employees have many options when it comes to choosing the health insurance plan that is best for them and their family. Review the different options to determine what is best suitable for you.

Benefit Eligibility

All regular and temporary employees who are eligible or who become eligible for the Wisconsin Retirement System (WRS) are eligible to participate.

For temporary employees, coverage with UWHC contribution is effective the 1st of the month following six months of Wisconsin Retirement System (WRS) participation. UWHC will pay 50% of the total monthly premium for the medical plan you elect. Until eligible for the UWHC contribution, temporary employees can elect early coverage and pay 100% of the premium. Early coverage can be effective the 1st of the month following the WRS eligibility date

  It's Your Choice Health Plan High Deductible Health Plan
Deductible $250 single/$500 family $1,500 single/$3,000 family
Out-of-Pocket Limit $1,250 single/$2,500 family for medical expenses $2,500 single/$5,000 family

$15 Primary care visit

$25 Specialty office visit

$75 Emergency room visit

Pay full cost for services until the deductible is met. 
Co-Insurance After deductible, you pay 10% up to OOPL 0% coinsurance
Flexible Spending Account (FSA) Eligible to enroll in a Health Care Flexible Spending Account to set aside pre-tax dollars to use for medically necessary expenses not covered by health insurance such as, deductibles and co-insurance, office or prescription co-pays, major dental expenses, glass or contacts and refractive surgery. Enrollment must be done annually. Eligble to enroll in a Limited Purpose Flexible Spending Account to pay for medically necessary vision and dental expenses not covered by health insurance, as well as health care costs after your annual deductible has been met. Enrollment must be annually.
Health Savings Account (HSA) Not eligible to enroll in a Health Savings Account.  If enrolled in the HDHP, employees must enroll in the associated Health Savings Account (HSA) annually.



Initial Enrollment

Enrollment in the State Group Health Insurance plan requires the submission of the Group Health Insurance Application to UW Health Human Resources within 30 days of the date of eligibility for the coverage.

For regular employees, coverage with UWHC contribution is effective the 1st of the month following completion of two months of Wisconsin Retirement System (WRS) enrollment. Early coverage with no UWHC contribution is available the 1st of the month following employment. Employee will be responsible for 100% of the monthly premium until the 1st of the month following completion of two months of WRS enrollment.

Note: If a New Hire has 2 or more months of prior Wisconsin Retirement System (WRS) state service, State Group Health Insurance coverage is effective the first day of the month following the date the application is received.

Qualifying Life Event

Changes may be made to your State Group Health insurance if a qualifying life event occurs. To make changes, please review Life Events (UWHC) page for information on what changes you can make due to a Qualifying Life Event, how to obtain the applications, and when the change is effective.  Completed applications must be submitted to UW Health Human Resources within 30 days of the qualifying life event.

A qualifying life event includes marriage, birth or adoption of a child, a death, divorce, termination of employment, or for dependent care only, a change in childcare providers or cost.

Open Enrollment

An annual enrollment period is offered for State Group Health Insurance each year during the Open Enrollment period. Open Enrollment takes place each year in the fall and is communicated through the In Brief. This is an employee’s opportunity, outside of a qualifying life event, to make changes to their benefits. 


I have elected not to participate in any of the health plans available at UW Hosptial employees. Do I get any kind of reimbursement?

UWHC offers a Health Insurance Opt-Out Incentive for employees who waive health insurance for calendar year 2016. An employee whose spouse, dependent or domestic partner is also a state, UW System or UWHC employee covered by state group health insurance is not eligible for the incentive. The incentive is paid out in installments throughout the year and will be considered taxable income.

What do I need to consider regarding health insurance if my spouse/domestic partner is also a state employee or annuitant?

If you don’t have children that you wish to enroll for health insurance, you may each enroll in a single plan. However, should one of you die, that individual’s unused sick leave would not be transferred to the surviving spouse to use to pay for post-retirement health insurance premiums. Typically, you can only change from single to family coverage during the fall open enrollment period (the coverage change would occur on January 1) or if you have a qualifying event such as birth or adoption of a child. If you have family coverage, a spouse to spouse transfer may occur during to the subscriber’s termination of employment, loss of eligibility or leave of absence.

What if my dependent children live elsewhere?

HMOs will provide insurance coverage outside of the service area in emergency and urgent care situations only. Routine care must be received from the HMO’s own providers. Only the Access Health Plan and WEA Trust allow you the flexibility to seek routine care outside a particular service area.

For more information about health insurance, refer to the Wisconsin Department of Employee Trust Funds (ETF) website.

When can I change my health insurance plan?

You may change to another offered health insurance plan during the open enrollment period that occurs in October. You can also change your level of coverage (single to family or vice versa) and add eligible dependents if they were not previously enrolled. The changes take effect on January 1. You may also change health plans and level of coverage due to a qualifying event, such as marriage, birth or adoption or loss of other coverage.

For more information about health insurance, refer to the Wisconsin Department of Employee Trust Funds (ETF) website.

Who is eligible as a dependent on my health insurance?

Eligible dependents are your same or opposite sex spouse or domestic partner, your children and children of your spouse or domestic partner. Children are eligible to be covered as your dependents until the end of the month in which they turn age 26.

Will I get a new health insurance card every year?

It depends on your health plan. Typically, you will only receive a new ID card if you change health plans. 


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