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Benefits to support the total you
The wellbeing of you and your family matters. This
at-a-glance guide provides an overview of the
health and financial benefits you’ll receive as an
employee at U.S. Bank.

Each year, we explore ways to improve your
benefits and resources – so whether you’ve been
with the company for a while, or just joined as
a new employee, use this guide to understand
what’s available to you for 2020.

Contents
Your benefit choices and start dates 2

Support for:
Your future financial wellbeing 3

A well mind and body 4

Your parenting journey 10

Your budget 11

Your most difficult times 13

Your life outside of work 15

Enhancements for 2020: Did you participate in
U.S. Bank benefits in 2019? Here are highlights of
the changes for 2020:

• We’re covering cost increases of your medical
and dental programs; these would have been
7% for medical and 3% for dental.

• 100% coverage for behavioral and mental
health office visits once you reach your
deductible. This applies for both network and
non-network providers, giving you greater
access to more affordable care.

• Enhanced dental coverage and
additional flexibility.

• Pharmacy coverage that’s integrated with your
medical coverage. This will make it simpler
and more convenient to manage your total
healthcare experience.

Benefits to support the total you
2020 BENEFITS AT A GLANCE

Look for these symbols throughout this document to identify the benefits for which you qualify based on your
employment status:

• Full-time: scheduled to work 30 or more hours per week

• Regular part-time: 20-29 hours per week

• Part-time: fewer than 20 hours per week

If you’re eligible, you can generally cover your qualifying dependents, too:

• Spouse or domestic partner (same- or opposite-sex)
• Children younger than 26
• Disabled children 26 or older

As a new or newly eligible employee, the benefits you select by your enrollment deadline will be set up as soon as
possible to help you avoid gaps in coverage. If you’re full-time, that’s the first of the month after your hire date. If you’re
regular part-time, a three-month waiting period applies (e.g., if you’re hired May 9, the benefits you elect begin Sept. 1).
Thereafter, you can change your benefits each November for the following year, unless you experience a life event that
allows you to add, drop or change earlier.

Your benefit
choices and
start dates

401(k) savings plan

You choose how to save and invest through before-tax and/or Roth
after-tax contributions and a variety of investment options. You’re
immediately vested and receive a 100% company match up to 4%
of eligible pay after a year of service. You’re automatically enrolled
with a 2% before-tax contribution to a target-date fund based on your
birthdate and retirement at age 65. Savings start on your first or
second paycheck, and you can change your contributions or
investments anytime.

Pension plan

Help build your retirement income with a cash balance pension benefit,
funded completely by U.S. Bank. You’re automatically enrolled on the
first Jan. 1 or July 1 after you reach age 21 and complete a year of
service in which you work at least 1,000 hours. Thereafter, each year you
work at least 1,000 hours, you’ll receive a pay credit (based on your age
and years of service) equal to a percentage of your eligible pay during
the year. You’ll also receive an annual interest credit on your account
balance. Once fully vested after three years of service, take your benefit
with you if you leave U.S. Bank or receive a benefit from the plan when
you retire.

Support for
your future
financial
wellbeing

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Your financial wellness matters throughout your career and into retirement. That’s why we invest in your future with
retirement savings and pension plans, and tools and resources to help you plan your journey.

Tools to help navigate your financial journey

Access your savings and retirement accounts,
project your future retirement income, get
investment help, assess your financial health
and more with our Your Total Rewards site.
With this one-stop resource, you also can see
your total compensation statement and explore
information about all the benefits and programs
that comprise your total rewards.

You can use Health Savings Account contributions you make and receive
from U.S. Bank during employment to pay your healthcare expenses in
retirement, too. See page 11 to learn more.

Support for
a well mind
and body

Feeling well helps power your potential at home, work and in all that you do. Choose from a variety of benefits and
programs to help you be at your best.

Medical and wellness

You have access to two distinctly different medical plans loaded with value-added features to make your experience
more comprehensive, integrated and convenient:

• Increases in premiums are paid for this year by U.S. Bank

• Broad network coverage administered by UnitedHealthcare/OptumRx for medical services and prescriptions and
EyeMed for routine annual eye exams

• Free preventive screenings, immunizations and prescriptions, regardless of whether you’ve met your deductible

• A variety of wellness and support programs

• A single administrator – UnitedHealthcare/Optum – for your medical and prescription coverage, Health Savings
Account (if applicable) and wellness programs for an integrated experience and continuity of your preventive and
ongoing healthcare.

The Copay Advantage plan features more certainty
around what you pay when you go to the doctor or
fill a prescription through:

• A lower deductible for medical services
• No deductible for prescriptions
• Free virtual visits
• Fixed copays for certain services

The HSA Advantage plan is a high deductible plan
you can pair with a Health Savings Account (HSA)
which offers:

• Lower premiums
• A tax-free way to save and pay for
out-of-pocket healthcare expenses
• An HSA contribution from U.S. Bank — up to
either $500 or $1,000 annually

UnitedHealthcare Copay Advantage
Plan (In-network)

UnitedHealthcare HSA Advantage Plan
(In-network)

Deductible
Medical: $500/person; $1,000/family
Pharmacy: Deductible waived

Combined medical/pharmacy:
$3,000/person; $5,000/family

Preventive medical/pharmacy $0 – deductible waived

Office visit charge

See “Other covered medical
services” for other services received
during an office visit

PCP, convenience clinic: $25
Specialist, urgent care: $50
Deductible waived
($0 for behavioral health after
deductible is met)

30% after deductible
($0 for behavioral health after
deductible is met)

Virtual visit $0 – deductible waived 30% after deductible

Emergency room $250 – deductible waived 30% after deductible

Other covered medical services 20% after deductible
($0 for behavioral health after
deductible is met if billed as
office setting)

30% after deductible
($0 for behavioral health after
deductible is met if billed as
office setting)

Retail pharmacy (30-day) 20%-45%; deductible waived 20%-45% after deductible

Home delivery pharmacy (90-day) $25 copay-45%; deductible waived $25 copay-45% after deductible

Out-of-pocket maximum
(combined medical/pharmacy)

$2,000/person
$4,000/family

$5,000/person
$10,000/family

HSA contribution from U.S. Bank Not eligible If you only cover yourself: $500
All other coverage levels: $1,000

Cost of coverage per biweekly pay
period

You: $87.38
You + spouse/partner: $239.88
You + children: $166.00
You + family: $344.69

Assumes no tobacco use

You: $39.50
You + spouse/partner: $121.23
You + children: $76.77
You + family: $147.88

Assumes no tobacco use

Similar plans are available through Kaiser in California, Colorado, Oregon and Washington at similar costs.
See my.kp.org/usbank for details.

Compare your options and what you pay for services

http://my.kp.org/usbank

Partners on the road to better wellbeing
In addition to the wellness components of our
medical plans, we support your total wellbeing
through:

50% reimbursement
on already discounted WW (Weight Watchers
reimagined) membership fees

Discounts
on fitness products and services

LifeWorks
challenges, wellness tools and health coaching

Monthly webinars and more

Specialized support to meet your personal needs

With either of our UnitedHealthcare medical plans, you receive
these valuable programs at no additional expense:

• 2nd.MD empowers you to confidentially speak to
an independent specialist about a diagnosis or differing
diagnoses from multiple doctors, surgery, a new course
of treatment, or prescription or treatment you’re not
sure is working.

• Livongo for Diabetes Program includes a connected
meter; anytime, anywhere coaching; and 100%
coverage for testing strips.

• Maternity Support Program to enhance your
understanding of what to expect, ease your concerns,
access useful information and resources, and prepare
for the best possible pregnancy and birth.

• Real Appeal digital weight loss and healthy living
program, which includes a personal coach, online
group classes, nutrition and fitness guides, food and
exercise trackers and more.

• Support programs for bariatric surgery, transplants,
cancer, fertility, spine and joint.

• Stop Smoking Program, including a quit coach
and nicotine replacement products to help you
become tobacco- and nicotine-free. Also available to
Kaiser members.

Mental health matters

Behavioral and mental health are an incredibly important
part of wellbeing. That’s why we provide:

• Coverage under our medical plans for diagnosis,
treatment, therapy and crisis intervention related to
mental health and behavioral health conditions, such
as depression, mental illness and substance abuse.
From virtual and office visits, to prior-authorized
inpatient, outpatient and residential treatment, we’ve
got you covered. With our UnitedHealthcare plans,
eligible expenses are covered at 100% after you reach
your deductible both in and out of network.*

• Confidential in-person counseling through LifeWorks
to help you cope with grief and loss, navigate personal
relationships, manage financial worries and solve family
or parenting concerns. It’s free for you and your family
members even if you’re not enrolled in a U.S. Bank
medical plan.

• Online resources and phone support from
LifeWorks, including:

– Life coaching to help you overcome obstacles,
move forward, create the life you want and reach
your goals.

– Health coaching for concerns affecting your
mind and body, like sleep, stress and
weight management.

Convenient options that fit your busy life

• 24/7 nurse line — Seek answers to your medical questions or determine the best level of care when enrolled in a
UnitedHealthcare plan.

• Virtual visits — Get free or low-cost care under UnitedHealthcare plans for a variety of ailments through your phone,
tablet or computer – anytime anywhere and without an appointment.

• Onsite health centers — See a nurse practitioner at one of our larger worksites to get more convenient care for
minor illnesses or medical services. It’s completely free to you – even if you’re not enrolled in a U.S. Bank
medical plan.

• myuhc.com — Find a network doctor or pharmacy, estimate costs, manage your claims, access your HSA, order
prescriptions and more. When you’re in a UnitedHealthcare medical plan, this one-stop resource integrates all your
medical, pharmacy, wellness and HSA information, resources and transactions.

* Applies to services billed as a behavioral health office visit as well as any additional behavioral health services received at that visit.

http://myuhc.com

Dental

Good dental care is an important part of your overall wellbeing. Choose from two dental plans to help keep your smile at
its best through regular dental checkups.

Basic Premium

$0 $0Preventive and diagnostic services

$50/person, $100/familyBasic and major services $50/person, $100/family

$0Orthodontia

100%Preventive and diagnostic 100%

80% after deductible Basic services 80% after deductible

50% after deductible Major services 80% after deductible

50% – for dependent children
under age 19

Orthodontia
50% – for adults and
dependent children

$1,000/person per calendar year
Annual maximum benefit for
preventive and diagnostic, basic
and major services

$1,500/person per calendar year

$1,000/dependent child per lifetime Lifetime orthodontia maximum $1,500/person per lifetime

Percentages shown indicate the percent of the “payment obligation/allowable charge” paid by the plan.

Premiums per biweekly pay period

Full-time employees You only – $6.00
You + spouse – $11.50
You + child(ren) – $12.50
You + family – $20.00

You only – $24.50
You + spouse – $48.25
You + child(ren) – $53.25
You + family – $84.00

Regular part-time employees You only – $11.31
You + spouse – $22.58
You + child(ren) – $24.19
You + family – $38.54

You only – $30.31
You + spouse – $60.35
You + child(ren) – $65.96
You + family – $104.23

Deductible (per calendar year)

Coverage

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Vision

Pay less for eyeglasses and contact lenses purchased through a variety of retail and private practice optometrists and
ophthalmologists in the EyeMed network. (Discounts on diagnostic hearing exams and hearing aids are also available.)
You pay from $4.18 to $11.52 per pay period depending on the family members you cover. Routine annual eye exams
are not provided under this plan; they’re covered under our medical plans.

Product/service

Frames

Your in-network cost

Standard plastic lenses with polycarbonate and anti-
reflective coatings (other lens options available for
additional cost)
Single vision, bifocal, or trifocal

Standard progressive

Premium progressive

$0 for frames up to $150 retail value; 80%
of balance over $150

$10 copay

$75 copay

Varies by type of lens from $95 to $120 copay, or $75
copay up to $120 retail value plus 80% of balance
over $120

Contact lenses (both eyes)
Conventional

Disposable (up to $150 retail value)

Medically necessary

$0 for lenses up to $150 retail value; 85%
of balance over $150

$0 for lenses up to $150 retail value; 100% of balance
over $150

$0 (paid in full by plan)

Lasik surgery from US Laser Network 85% of regular retail price; 95% of promotional price

Hearing

Get diagnostic hearing exams and hearing aids through Epic’s national network of audiologists and ear, nose and throat
specialists. (This coverage is more extensive than the discounts provided under the vision plan.) You pay from $0.38 to
$.92 per pay period depending on the family members you cover. Routine hearing exams are not provided under this
plan; they’re covered under our medical plans.

In-network benefit Frequency
Your in-network cost/
discount

Diagnostic exam Adults: Once every 24 months
Children: Once every 12 months

Hearing aids Adults: Once every 60 months
Children: Once every 24 months

$500 off per ear; includes three-
year warranty and one-year battery
supply

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Support for
your parenting
journey

Your family life matters. Save money, bring harmony to your work and home lives, and access practical resources and
assistance with these programs.

Adoption assistance: Reimbursement of up to $10,000

Bright Horizons: Ten days of discounted backup child and elder care and related resources

Dependent care flexible spending account: Pay for up to $5,000 of daycare expenses with
pre-tax dollars

Fertility Solutions Program: Education, counseling and support plus coverage of up to $25,000 for
medical and surgical expenses and $10,000 for prescriptions when enrolled in a UnitedHealthcare
medical plan

Lactation breaks and mothers’ rooms: Time and a private space to express milk at work

Leaves of absence: 13 weeks of paid leave (a combination of pregnancy disability leave and parental
leave) for the birth parent and four weeks of paid parental leave for non-birth parents

Maternity Support Program: Free when you’re enrolled in a UnitedHealthcare medical plan (see page 6)

Surrogacy assistance: Reimbursement of up to $10,000

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Support for
your budget

Your bottom line matters. Make the most of your spending with pre-tax savings and valuable discounts.

Health Savings Account (HSA)

An HSA provides a tax-advantaged means for you to save and pay for qualified healthcare expenses, including doctor
and dentist visits, prescriptions, glasses, contact lenses and more. Enroll in a U.S. Bank HSA Advantage medical plan
to contribute and to receive up to $500 (if you cover yourself) or up to $1,000 (if you also cover one or more family
members) annually from U.S. Bank. You own your HSA and all the money in it, even if you change medical plans or
employment. There is no deadline to use your HSA balance, so you can save for future medical expenses, too, including
those you may have in retirement.

Flexible Spending Accounts (FSAs)

Save on taxes when you pay for expenses with pre-tax dollars with our FSAs. Estimate your expenses carefully, in most
cases, you’ll lose any money not used for the year.

Healthcare FSA (either general purpose or limited purpose depending on your HSA eligibility) for
qualifying medical, dental, vision and hearing expenses. Your entire annual contribution amount is
available at the beginning of the year. You may carry up to $500 to the next year if you enroll again the
following year, but you’ll lose any additional unused balance.

Dependent care FSA for daycare expenses.

Parking FSA for work-related parking expenses.

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Commuter plans

Choose the Transit Plan to purchase your transit or vanpool
vouchers before-tax and enjoy the convenience of receiving
them at your home. Or in the seven-county Minneapolis/St.
Paul metropolitan area, purchase a Metropass at a reduced
price. With either, U.S. Bank contributes $35 toward your
commuting expense every month you participate.

Discounts and reimbursements

Maximize your spending on day-to-day and major
expenses:

• Exclusive employee offers on U.S. Bank financial
products and services

• Tuition reimbursement

• 50% reimbursement of already discounted WW
(formerly Weight Watchers) membership fees

• Discounts through Abenity on gym memberships,
hotels, restaurants, movie theaters, retailers, florists,
car dealers, national attractions, concerts, events
and more.

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Support for
your most
difficult times

Your peace of mind matters. Rest easy with programs that replace a portion of your income if you’re unable to work,
protect your or your loved ones’ financial future and lend a caring hand in challenging times.

Sick and Safe Leave

When you need time off for medical appointments, personal illness or the illness of a family member, and other reasons
as allowed by law, Sick and Safe Leave has you covered. Accrue one hour for every 30 hours worked up to 80 hours
each calendar year (except if you work in California or Washington where there’s no accrual limit) and carry up to 80
hours over to the next year. Accrued time is capped at 80 hours at any given time.

Short-term and long-term disability

If you’re unable to work due to illness or injury and have at least a year of service, you may be eligible to receive 100%
pay replacement for up to 13 weeks and 60% for another 13 weeks, if needed, under short-term disability. If you’re
still unable to work after 26 weeks, Long-Term Disability (LTD) applies. At enrollment, you elect either 50 or 60% pay
replacement for LTD. If you’re full-time, you receive the 50% of pay coverage option at no cost and may buy-up to 60%.

Term life insurance

If you’re a full-time employee, you automatically receive term life insurance coverage equal to your annual pay (up to
$300,000) at no cost and you have the option to purchase more. If you’re regular part-time, you can purchase up to
eight times your annual pay ($4 million maximum). During your initial enrollment, select up to three times pay ($750,000
maximum) without evidence of insurability. At subsequent annual enrollments, you may purchase or increase coverage
by one-times pay (up to the lesser of three times pay or $750,000) without evidence of insurability.

Dependent term life policies are available, too. For your spouse or domestic partner, choose up to $100,000. At your
initial enrollment, up to $50,000 is available without evidence of insurability. At subsequent annual enrollments, evidence
of insurability is required for new or increased coverage. For your children, choose up to $25,000 without evidence of
insurability. You may increase coverage during future annual enrollments or during the year if you experience a qualifying
status change. You can even continue employee and dependent policies if you leave U.S. Bank, with certain restrictions.

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Business Travel Accidental (BTA) death and dismemberment insurance

You are protected by BTA insurance at no cost to you. It provides a benefit if you die or sustain certain injuries at work or
while traveling on U.S. Bank business.

Accidental Death and Dismemberment (AD&D) insurance

Elect coverage for yourself or you and your family in multiple coverage levels for protection in the event of accidental
death and certain accidental injuries and conditions.

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A helping hand anytime, anywhere
No issue is too big and no question is too small for
LifeWorks. Get practical information, resources, tools
and support that can assist with all of life’s challenges
– personal and professional, financial, legal, health,
family, relationships and more. From research and
general support to coaching, counseling and critical
assistance in a crisis, you can count on confidential
24/7 assistance from LifeWorks.

Support from employees for employees
Funded by employee donations, our Employee
Assistance Fund provides one-time grants to help
employees experiencing financial hardship due to
unexpected events, like destructive fires or storms,
illness or death of a family member or military
deployment.

Time away when it matters most
In addition to vacation time and disability, parental
and sick leaves, you may have access to other time
away – including funeral and bereavement time, family
medical leave and personal leaves – to care for your
personal priorities.

Support for
your life
outside of
work

Work is just one part of your life. Relax, recharge and connect with your friends, family and community with paid time off.

Vacation

Your paid vacation is based on your scheduled hours, years of service and job grade. It generally ranges from two to four
weeks per year as a new employee. You begin earning vacation the first of the month following three full months at the
company (e.g., if you start on Jan. 18, you begin earning vacation on May 1).

Purchased vacation

Each annual enrollment, you may purchase up to one week of additional vacation in one-hour increments, not to exceed
your scheduled weekly hours.

Empowering you in your community

We believe in making our communities the best places to live, work and play. That’s why we encourage you to take up
to 16 hours of paid time off with Volunteer Days. And through our Dollars for Doing program, we monetarily match
the time you volunteer outside of your scheduled work hours. We also match your charitable contributions up to $1,000
each year.

This document provides highlights of various U.S. Bank employee benefits, programs and policies. See official plan/
program documents for qualifications, limitations and details. In all cases, the official plan/program documents govern.

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Welcome
to the University of Wisconsin–Madison

New Employee Benefits Summary | 2020
For employees covered by the Wisconsin Retirement System (WRS)

with appointment start dates between December 2, 2019–December 1, 2020

•

University Staff

• Academic Staff
• Faculty
• Limited Appointees

Office of Human Resources
21 N. Park Street, Suite 5101

Madison, Wisconsin 53715-1218

Walk-ins: 9 am–3 pm
(first-come, first-served)

INFORMATION IN DIFFERENT LANGUAGES

ENGLISH
If you have any questions about this information, please contact us at benefits@ohr.wisc.edu or (608)
262-5650 to communicate in English. If you would like to request translation or interpretation services,
please call Cultural Linguistic Services (Office of Human Resources) at (608) 265-2257. Thank you.

Welcome to the University of Wisconsin–Madison!

This packet includes information regarding the benefit plans UW–Madison offers you
and your family. Whether you are interested in health, dental, vision, or life insurance
benefits, we are confident you will find plans that suit your needs. The University
contributes toward the cost of several benefit plans adding to your total compensation.

Selecting your benefits is an important process. We encourage you to read this
information promptly and thoroughly as some plans require enrollment within the first
30 days of employment, or of becoming a benefits-eligible employee.

Visit our website for more information: hr.wisc.edu/benefits

If you have questions about your benefits, please contact UW–Madison Benefits Services
at benefits@ohr.wisc.edu or 608-262-5650.

Once again, welcome to UW–Madison.

On Wisconsin!

Benefits 101
Presentation for New Employees

For employees covered by the Wisconsin Retirement System (WRS)

Presented by: UW–Madison Office of Human Resources, Benefit Services

Welcome to the University of Wisconsin–Madison!

If you are a new employee, or an existing employee who is newly covered by the Wisconsin
Retirement System, register for this session within your first 30 days!

Features

• An overview of your extensive UW benefits package; your choices and options
• An explanation of the information and forms on the benefits website, hr.wisc.edu/benefits
• An introduction to the mandatory Wisconsin Retirement System and optional retirement programs
• A question and answer session with a benefits expert
• You will receive a personalized worksheet with your enrollment deadlines

Locations

Most Benefits 101 sessions are held at 21 N. Park Street. Some sessions are held at Union South or other campus loca-
tions. Be sure to check the location of the session for which you have registered.

Visit hr.wisc.edu/benefits for complete comprehensive benefits information.

If you have questions, contact benefits@ohr.wisc.edu.

21 N. Park Street, southeast campus areaUW–Madison, southeast overview map

This benefit summary is an overview of UW–Madison employee benefits. For more detailed information, applications,
guides, and booklets, visit hr.wisc.edu/benefits.

Introduction
Coverage Deadlines and Effective Date of Coverage . . . . . . . 6
New Employee Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Benefits Website: hr.wisc.edu/benefits
Benefits 101: Benefits Presentation for New Employees
Ask ALEX: Your Personalized Online Benefits Counselor
Benefits Walkthrough
Completing Benefit Applications . . . . . . . . . . . . . . . . . . . . . . . 6

Benefit Plans
Wisconsin Retirement System . . . . . . . . . . . . . . . . . . . . . . . . . 7
State Group Health Insurance . . . . . . . . . . . . . . . . . . . . . . . . 8
Comparison of Health Plan Benefit Options . . . . . . . . . . . . . 10
Delta Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
VSP Vision Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Income Continuation Insurance . . . . . . . . . . . . . . . . . . . . . . . 18
State Group Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Individual and Family Group Life Insurance . . . . . . . . . . . . . . 19
UW Employees, Inc. Life Insurance . . . . . . . . . . . . . . . . . . . . 20
University Insurance Association Life Insurance . . . . . . . . . . 20
Accidental Death and Dismemberment Insurance . . . . . . . . 21
Accident Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Flexible Spending Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Tax-Sheltered Annuity 403(b) Program . . . . . . . . . . . . . . . . . 23
Wisconsin Deferred Compensation . . . . . . . . . . . . . . . . . . . . 24

Every effort has been made to ensure the information in this benefit summary is true and accurate. If there is any discrep-
ancy between this summary and the official plan documents, the language in the official documents shall be considered
accurate.

To enroll and participate in the benefit plans outlined in this document, you must meet all eligibility requirements as de-
fined by the Wisconsin Retirement System, Wisconsin State Statutes, and University personnel rules.

Table of Contents

52020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Coverage Deadlines and Effective Date of Coverage
Most benefit plans have a 30 day enrollment period from the start date of your appointment. Some plans have additional
requirements.

If you do not enroll during your initial enrollment opportunity, you may have an opportunity to enroll during an open
enrollment event (usually held in the fall), or if you experience a life event such as marriage, domestic partnership, birth
or adoption, or loss of other coverage. You will typically have 30 days from a life event to make changes to your benefits.
Contact your department HR Payroll & Benefits contact as soon as a life event occurs. Coverage effective dates vary by
plan. For some plans you may also have an opportunity to enroll through evidence of insurability.

New Employee Resources
The resources listed below will help you review your benefits options and make informed choices. Please use these
resources that have been designed for you.

• Benefits Website
For detailed information about the benefit plans included in this summary, visit the UW–Madison Benefits Services
website: hr.wisc.edu/benefits

• Benefits 101: Benefits Presentation for New Employees
If you are a new employee, or an existing employee who is newly covered by WRS, register for Benefits 101 within
your first 30 days: hr.wisc.edu/benefits-101

• Ask ALEX: Your Personalized Online Benefits Counselor
ALEX is an online resource to help you better understand the comprehensive benefits offered to UW–Madison em-
ployees. ALEX will ask you a series of questions to walk you through your benefits options and suggests plans based
on your answers. Before you make your benefits elections, let ALEX explain your options.
Get started: myalex.com/uwsystem/2020

The Ask ALEX tool doesn’t answer everything. For additional information, contact benefits@ohr.wisc.edu with any
questions prior to enrolling in a new plan.

• Benefits Walkthrough
The Benefits Walkthrough is an online tool designed to assist you in determining your benefit plan options and
estimating your premiums. The Walkthrough will produce a worksheet summarizing your selections, but it will not
enroll you in the benefits plans.
Start the Walkthrough: uwservice.wisconsin.edu/ebenefits

See your department HR Payroll & Benefits contact for help with the following, or visit the listed website:

• Pay schedules: hr.wisc.edu/pay

• Leave benefits: hr.wisc.edu/benefits/leave/paid-leave

• Transportation and parking: transportation.wisc.edu

Completing Benefit Applications
Complete your benefit enrollments using Self Service (eBenefits) through MyUW. Some benefit enrollments may require
a paper application or additional documentation. Work with your department HR Payroll & Benefits contact for assis-
tance completing your timely enrollment elections.

In addition to your benefit applications, there are many essential forms that you must complete as a new employee, such
as the Employee WIthholding Form W-4 and the Direct Deposit Authorization Form. If you have not yet completed these
forms, visit hr.wisc.edu/new-employees or see your department HR Payroll & Benefits contact.

6 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Wisconsin Retirement System
Plan Description

Wisconsin Retirement System (WRS) participation is automatic for all eligible employees, with coverage beginning on the
first day an employee is eligible. Your retirement income will be based on your years of service, your age at retirement,
and the average of your highest three years of earnings or based on the total cash value of your account, whichever is
greater. WRS also provides death, permanent disability, and separation benefits.

For detailed information about the WRS: hr.wisc.edu/benefits/wisconsin-retirement-system

There is a five year vesting requirement if you were hired on or after July 1, 2011 and have no WRS credible service prior
to July 1, 2011. You are immediately vested if you have WRS service prior to July 1, 2011.

WRS consists of a Core Fund and a Variable Fund. By default, 100% of retirement contributions are deposited in the Core
Fund, which is a diversified fund with investments in stocks, bonds and more. If you elect to participate in the Variable
Fund, 50% of the required contributions and additional contributions made after your election will be deposited in the
Variable Fund. The Variable Fund is invested in stocks only. Unlike the Core Fund, there is no limit on Variable Fund annu-
ity decreases.

Each year, around mid-April, you will receive a Statement of Benefits from the WI Department of Employee Trust Funds
(ETF), which contains important WRS account information that will eventually be used in benefit calculations.

Available Coverage

WRS participation is automatic for all eligible employees.

Employee/Employer Contribution

The required 2020 contribution for most employees is 13.5% of gross earnings. Employees are required to contribute
6.75% of their salary to their WRS account. The University contributes 6.75% of your salary to your WRS account. WRS
contributions are subject to IRS limits – both you and the University pay WRS contributions on the first $285,000 in calen-
dar year earnings. The limit for the 2019–2020 fiscal year is $282,500.

Contributions are taken on a pre-tax basis for federal and state income tax purposes. Contribution rates are set on an
annual basis by ETF.

72020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

State Group Health Insurance
Plan Description

The State Group Health Insurance plan provides comprehensive medical coverage, a Well Wisconsin $150 incentive
through StayWell, and prescription coverage administered through Navitus. All health plans have an option to include
dental coverage for diagnostic and preventive services. See the Dental page for coverage information.

You can choose between an IYC Health Plan (formerly known as Coinsurance Uniform Benefit plan) or a High

Deductible

Health Plan (HDHP). The HDHP offers lower monthly premiums in exchange for a higher deductible. The annual deduct-
ible ($1,500 single / $3,000 family) must be met before any medical, dental or prescription drug costs are paid for, with
the exception of preventive services. Each health plan offers a HDHP option.

If you elect the HDHP option, you are required to open a Health Savings Account (HSA) that helps pay for qualified
medical expenses. If you are covered by another health insurance plan, including Medicare or Tricare, or participate in a
Flexible Spending Account (including coverage by a spouse’s FSA), you are not eligible for a HDHP.

For detailed information regarding the State Group Health Insurance program see the It’s Your Choice Guide available at
etf.wi.gov/its-your-choice/2020/20et-2107/direct. To review a hard copy, contact your department HR Payroll & Benefits
contact.

Opt-Out Incentive

You may be eligible to receive up to $2,000 (pro-rated for the number of months coverage is waived) if you opt out of
State Group Health Insurance coverage. To opt out, you must submit your election to opt out within 30 days of your eligi-
bility date. Craft workers are not eligible for the incentive.

Available Coverage

Coverage is available for the employee, employee spouse and dependents.

Employee/Employer Contribution

State Group Health Insurance premiums are paid through a combination of employer and employee contributions.
University Staff who elect coverage to begin immediately with their appointment start date must pay both the employer
and employee contribution for the first two months of coverage.

2020 Premiums for WRS Covered Employees

State Group Health Insurance Plans
Medical With Dental Medical Without Dental

Single Family Single

Family

Health Plan $93.00 $231.00 $89.00 $222.00

HDHP $35.00 $87.00 $31.00 $78.00

Access Health Plan $273.00 $679.00 $269.00 $670.00

Access HDHP $215.00 $535.00 $211.00 $526.00

Access Health Plan (Tier 2*) $147.00 $367.00 $143.00 $358.00

Access HDHP (Tier 2*) $89.00 $223.00 $85.00 $214.00

*required to work out of state

NOTE: Employees working below 50% time (and LTEs with one appointment) must pay 50% of the
entire premium for their health plan.

8 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Comparison of Benefit Options

The charts on the following pages are designed to compare Health Plans, High Deductible Health Plans, and the Access
Plan. The outlines are not intended to be a complete description of coverage. The Access Plan details are located in the
Access Plan (ET-2112) benefits booklet.

Federally required Summaries of Benefits and Coverage (SBCs) and the Uniform Glossary are available through
etf.wi.gov/its-your-choice/2020/state-employee-retiree-health-plan/health-insurance-employees-cobra-and-retir-
ees-without-medicare/summary-benefits-and-coverage. If you need printed copies sent to you, please call the Depart-
ment of Employee Trust Funds (ETF) at 1-877-533-5020 to let them know which plan’s Summary of Benefits and Cover-
age you want.

Enrollment and Effective Date of Coverage

You must apply within 30 days of your appointment start date.

Coverage is effective the first of the month on or following your appointment, as long as your application is received
within 30 days.

Examples:

• If you are hired on January 1, and your application is received by January 31, coverage is effective on January 1.
• If you are hired on any day of the month after the 1st, and your application is received within 30 days, coverage is
effective on the first of the month following your date of hire.

University Staff must complete two full months of WRS service in order to receive employer contribution toward health
insurance premiums. You must apply within 30 days of your appointment start date even if you elect to delay your effec-
tive date of coverage.

Any employee not electing to enroll in State Group Health insurance coverage must submit an application to decline
coverage.

92020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

2020 State – Comparison of Benefits Options

Benefit Health Plan
Access Plan

In-Network Out-of-Network

Annual Medical
Deductible

$250 individual /
$500 family

Deductible applies to
annual OOPL

After an individual
within a family plan
meets the $250
deductible, coinsurance
will apply to covered
medical services except
for office visit
copayments

Medical deductible does
not apply to prescription
drugs

$250 individual /
$500 family
Deductible applies to
annual OOPL
After an individual
within a family plan
meets the $250
deductible, coinsurance
will apply to covered
medical services except
for office visit
copayments
Medical deductible does
not apply to prescription
drugs

$500 individual /
$1,000 family

Deductible applies to
annual OOPL

After an individual
within a family plan
meets the $500
deductible, coinsurance
will apply to covered
medical services except
for office visit
copayments

Medical deductible does
not apply to prescription
drugs

Primary Care Physician
Office Visit Copayment
includes:

• Internist
• General Physician
• Family Practitioner
• Pediatrician
• Gynecologist /
Obstetrician
• Nurse Practitioner
• Physician Assistant
• Chiropractor
• Physical /
Occupational / Speech
Therapy in an office
visit setting

$15 per visit

Office visit copayments
are not subject to the
deductible, but do apply
to the annual OOPL

$15 per visit
Office visit copayments
are not subject to the
deductible, but do apply
to the annual OOPL

After deductible: 30%
member cost up to the
annual OOPL

Specialty Office Visit
Copayment includes:

• Specialty Providers
• Urgent Care
• Vision Exam in an
office visit setting

$25 per visit

Office visit copayments
are not subject to the
deductible, but do apply
to the annual OOPL
$25 per visit
Office visit copayments
are not subject to the
deductible, but do apply
to the annual OOPL
After deductible: 30%
member cost up to the
annual OOPL

10 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Annual Medical
Coinsurance

After deductible: 10%
member cost

Applies to medical
services except for
office visits

Coinsurance applies to
the annual OOPL

After deductible: 10%
member cost
Applies to medical
services except for
office visits
Coinsurance applies to
the annual OOPL

After deductible: 30%
member cost

Applies to medical
services

Coinsurance applies to
the annual OOPL

Annual Medical Out-of-
Pocket Limit (OOPL)

$1,250 individual /
$2,500 family

$2,000 individual /
$4,000 family

Routine, preventive
services as required by
federal law

Plan pays 100% Plan pays 100%
Subject to the
deductible, copayments
and/or coinsurance

Illness/injury related
services beyond the
office visit copayment (if
applicable)

After deductible: 10%
member cost up to
OOPL

After deductible: 10%
member cost up to the
annual OOPL

After deductible: 30%
member cost up to the
annual OOPL

Emergency Room
Copayment (Waived if
admitted as an inpatient
directly from the
emergency room or for
observation for 24
hours or longer.)

$75 copayment per
visit, then the deductible
and coinsurance
applies to services
beyond the copayment
up to the OOPL

$75 copayment per
visit, then in-network
deductible and
coinsurance applies to
services beyond the
copayment up to the
OOPL

112020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

2020 State – Comparison of Benefits Options for Prescription Drugs

Drug Level Health Plan
Access Plan

In-Network Out-of-Network

Deductible

None None

Copayment / Coinsurance

Level 1 $5 $5

Level 2 20% ($50 max) 20% ($50 max)

Level 3

If you have a medical need and cannot
take the generic equivalent, your M.D.

must submit an FDA MedWatch form to
Navitus for the prescription. With the form,
you pay a 40% coinsurance (with a limit of

$150). Without the form, you pay 40%
plus the cost difference between the

brand name drug and its generic
equivalent. Contact Navitus for details.

If you have a medical need and cannot
take the generic equivalent, your M.D.
must submit an FDA MedWatch form to
Navitus for the prescription. With the form,
you pay a 40% coinsurance (with a limit of
$150). Without the form, you pay 40%
plus the cost difference between the
brand name drug and its generic
equivalent. Contact Navitus for details.

Level 4
Preferred

$50
Must fill at Lumicera or

UW Health Specialty Pharmacy

$50
Must fill at Lumicera or
UW Health Specialty Pharmacy

Out-of-Pocket Limits

Levels 1 & 2 $600 / $1,200 $600 / $1,200

Level 3 $6,850 / $13,700 $6,850 / $13,700
Must use

In-Network
pharmacy

Level 4 $1,200 / $2,400 $1,200 / $2,400

12 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

2020 State – Comparison of Benefits Options

Benefit HDHP
Access HDHP

In-Network Out-of-Network
Annual Medical
Deductible

$1,500 individual /
$3,000 family

The deductible must be
met before coverage
begins; for family
coverage, the full family
deductible must be met

The deductible includes
prescription drugs and
applies to the annual
OOPL

$1,500 individual /
$3,000 family

The deductible must be
met before coverage
begins; for family
coverage, the full family
deductible must be met

The deductible does
apply to prescription
drugs and also to the
annual OOPL

$2,000 individual /
$4,000 family
The deductible must be
met before coverage
begins; for family
coverage, the full family
deductible must be met

The deductible includes
prescription drugs and
applies to OOPL

Primary Care Physician
Office Visit Copayment
includes:
• Internist
• General Physician
• Family Practitioner
• Pediatrician
• Gynecologist /
Obstetrician
• Nurse Practitioner
• Physician Assistant
• Chiropractor
• Physical /
Occupational / Speech
Therapy in an office
visit setting

After deductible: $15
per visit

Office visit copayments
apply to the annual
OOPL

After deductible: $15
per visit

Office visit copayments
do apply to the annual
OOPL

After deductible: 30%
member cost up to the
annual OOPL

Specialty Office Visit
Copayment includes:
• Specialty Providers
• Urgent Care
• Vision Exam in an
office visit setting

After deductible: $25
per visit

Office visit copayments
apply to the annual
OOPL
After deductible: $25
per visit
Office visit copayments
do apply to the annual
OOPL
After deductible: 30%
member cost up to the
annual OOPL

132020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Annual Medical
Coinsurance

After deductible: 10%
member cost

Applies to medical
services except for
office visits

Coinsurance applies to
the annual OOPL
After deductible: 10%
member cost
Applies to medical
services except for
office visits
Coinsurance applies to
the annual OOPL

After deductible: 30%
member cost

Applies to medical
services except for
office visits
Coinsurance applies to
the annual OOPL
Annual Medical Out-of-
Pocket Limit (OOPL)

$2,500 individual /
$5,000 family

$3,800 individual /
$7,600 family

Routine, preventive
services as required by
federal law

Plan pays 100% Plan pays 100%
Subject to the
deductible and
coinsurance

Illness/injury related
services beyond the
office visit copayment (if
applicable)
After deductible: 10%
member cost up to
OOPL
After deductible: 10%
member cost up to the
annual OOPL
After deductible: 30%
member cost up to the
annual OOPL
Emergency Room
Copayment (Waived if
admitted as an inpatient
directly from the
emergency room or for
observation for 24
hours or longer.)

After deductible: $75
copayment per visit,
then coinsurance
applies to services
beyond the copayment
up to the OOPL

After deductible: $75
copayment per visit,
then the deductible and
coinsurance applies to
services beyond the
copayment up to the
OOPL

After deductible: $75
copayment per visit,
then in-network
deductible and
coinsurance applies to
services beyond the
copayment up to the
OOPL

14 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

2020 State – Comparison of Benefits Options for Prescription Drugs
Drug Level Health Plan
Access Plan
In-Network Out-of-Network
Deductible
None None
Copayment / Coinsurance
Level 1 $5 $5
Level 2 20% ($50 max) 20% ($50 max)
Level 3
If you have a medical need and cannot
take the generic equivalent, your M.D.
must submit an FDA MedWatch form to
Navitus for the prescription. With the form,
you pay a 40% coinsurance (with a limit of
$150). Without the form, you pay 40%
plus the cost difference between the
brand name drug and its generic
equivalent. Contact Navitus for details.
If you have a medical need and cannot
take the generic equivalent, your M.D.
must submit an FDA MedWatch form to
Navitus for the prescription. With the form,
you pay a 40% coinsurance (with a limit of
$150). Without the form, you pay 40%
plus the cost difference between the
brand name drug and its generic
equivalent. Contact Navitus for details.
Level 4
Preferred
$50
Must fill at Lumicera or
UW Health Specialty Pharmacy
$50
Must fill at Lumicera or
UW Health Specialty Pharmacy
Out-of-Pocket Limits
Levels 1 & 2 $600 / $1,200 $600 / $1,200
Level 3 $6,850 / $13,700 $6,850 / $13,700
Must use
In-Network
pharmacy
Level 4 $1,200 / $2,400 $1,200 / $2,400

152020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Dental and Vision Plans
UW-Madison offers dental and vision plans that provide coverage beyond the Uniform Dental and vision exam that may
be covered under your State Group Health Insurance plan. You are eligible for the dental and vision plans if you are eligi-
ble for State Group Health Insurance. The Uniform Dental option listed below is only available through your State Group
Health Insurance plan.

Delta Dental

Uniform Dental &
Preventive Plan Select Plan Select Plus Plan

In-Network providers
(No out-of-network coverage)

Delta Dental PPO &
Premier providers

Delta Dental PPO
Delta Dental PPO &
Premier providers

Annual deductible None $100 / person $25 / person

Annual benefit max $1,000 / person $1,000 / person $2,500 / person

Waiting period None None None

Routine evaluations, dental cleanings,
sealants, bitewing and panoramic
X-rays, fluoride treatments, pulp vitality
tests

100% No coverage No coverage

Fillings 100% No coverage No coverage

Anesthesia (general and IV sedation) 80% 50% 80%

Emergency pain relief 80% No coverage No coverage

Periodontal maintenance 100% No coverage No coverage

Crowns, bridges, dentures, implants No coverage 50% 60%

Surgical extraction, root canal
(endodontics), periodontics (except
maintenance), oral surgery

No coverage 50% 80%

Non-surgical extractions
(above gumline)

90% No coverage No coverage

Orthodontics coverage
50%

(Under age 19)
No coverage

50%
(Any age)

Orthodontics lifetime maximum $1,500 No coverage $1,500

What is Covered

Uniform Dental Preventive Plan Select Plan Select Plus Plan

Individual $4 $30.20 $9.28 $16.82

Individual + Child(ren) — — $12.52 $31.12

Individual + Spouse — — $18.56 $33.64

Family $9 $75.50 $22.28 $51.30

Monthly Cost (Premium)
The Uniform Dental premium is added to your health insurance premium. Preventive Plan, Select Plan and
Select Plus Plan are separate deductions.

16 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

VSP Vision
Plan Description

VSP Vision insurance provides coverage to help offset the costs of an annual eye exam, prescription glasses, and contact
lenses. For detailed information about VSP Vision: hr.wisc.edu/benefits/vsp-vision-insurance

In-Network coverage includes:

• One well-vision exam per calendar year after $15 co-payment

• Coverage for glasses or contact lenses each year

o $150 retail frame allowance (or $200 retail frame allowance for featured frame brands) every other year
after $25 co-pay, lenses every year after $25 co-pay

o $150 contact lens allowance per year with co-pay up to $40

• There is no charge for standard progressive lenses.

• Discounts may be available on services not covered by the plan, such as additional glasses, laser vision correc-
tion, and some services/materials.

• KidsCare Program – allows two exams per year, impact resistant lenses, lenses replaced as needed, frames
replaced annually with $25 co-pay

Available Coverage
Coverage is available for the employee, employee spouse and dependents.
Employee/Employer Contribution

There is no employer contribution.

Premiums

2020
Monthly

Premium

Employee
Employee +
Spouse/DP

Employee +
Child(ren)*

Family

VSP $6.38 $12.76 $14.38 $22.98

Enrollment and Effective Date of Coverage

You must apply within 30 days of your appointment start date.

Coverage is effective the first of the month on or following your appointment, as long as your enrollment is received
within 30 days.

Examples:

• If you are hired on January 1, and your enrollment is received by January 31, coverage is effective on January 1.

• If you are hired on any day of the month after the 1st, and your enrollment is received within 30 days, coverage is
effective the first of the month following your date of hire.

172020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Income Continuation Insurance
Plan Description

Income Continuation Insurance (ICI) is disability/income replacement insurance that will provide you with up to 75% of
your monthly salary (based on a maximum salary of $120,000/year) if you become ill or disabled and are unable to work.

Benefits begin after a selected waiting period (minimum of 30 consecutive calendar days) or use of accumulated sick
leave (up to 130 days), whichever is longer. There are two coverage levels: Standard ICI covers earnings up to $64,000;
Supplemental ICI covers earnings from $64,001 to $120,000.
For detailed information about ICI: hr.wisc.edu/benefits/income-continuation-insurance

Available Coverage

Coverage is available for the employee only.

Employee/Employer Contribution

ICI premiums are paid through a combination of employer and employee contributions. When coverage is elected deter-
mines the coverage option and the amount of employer and employee contributions.

Enrollment and Effective Date of Coverage

Faculty/Academic Staff/Limited Staff

You can elect coverage to be effective as soon as possible, but there is no employer contribution toward premiums
until after completion of 12 full months of WRS service. You must apply within 30 days of your appointment start date.
Coverage is effective on your hire date if you were hired on the 1st of a month. If you were hired any day after the 1st,
coverage is effective on the first of the month following your hire date.

If you elect coverage to become effective when the employer contributes to the premium, you must apply within 60 days
after completing one year of WRS service. Coverage is effective on the first day of the month after the completion of one
year of WRS service.

University Staff

You must apply within 30 days of your appointment start date. Coverage is effective on the 1st of the month on or fol-
lowing the date of hire.

All employees must be under age 70 to be eligible. Any employee not electing to enroll in ICI must submit an enrollment
to decline coverage.

18 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Life Insurance Plans
The University offers life insurance coverage through several different plans.

Plan descriptions for the life insurance plans available to you are listed on the following pages. Comparison charts high-
lighting the features: wisconsin.edu/ohrwd/benefits/download/life/lifecomp

Life Insurance Premiums

Premiums for all life insurance plans are available here: wisconsin.edu/ohrwd/benefits/premiums/#life

State Group Life Insurance
Plan Description

State Group Life Insurance (SGL) provides group term life insurance. SGL offers coverage levels of up to five times your
annual salary. There is also an option to cover your spouse up to $20,000 and your children up to $10,000. SGL will also
continue into retirement at the group policy rates.
More information: hr.wisc.edu/benefits/state-group-life-insurance

Available Coverage
Coverage is available for the employee, employee spouse and dependents.
Employee/Employer Contribution

SGL Insurance premiums are paid through a combination of employer and employee contributions

Enrollment and Effective Date of Coverage
You must apply within 30 days of your appointment start date.

Coverage is effective on the first of the month following 30 days from the appointment start date.

If you elect to not enroll in State Group Life insurance, you must submit an enrollment to decline coverage.

Individual and Family Group Life Insurance
Plan Description

The plan provides group term life insurance. Initially, you may select up to $20,000 of coverage for yourself, up to
$10,000 for a spouse/domestic partner, and up to $5,000 per child. Maximum employee coverage is $300,000, $150,000
for a spouse/domestic partner, and $25,000 per child. Annually, participants have an opportunity to increase coverage
without evidence of insurability. More information: hr.wisc.edu/benefits/individual-and-family-group-life-insurance

Available Coverage

Coverage is available for the employee, employee spouse or domestic partner and dependents.

Enrollment and Effective Date of Coverage
You must apply within 30 days of your appointment start date.
Coverage is effective on the first of the month following 30 days from the appointment start date.

192020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

UW Employees, Inc. Life Insurance
Plan Description

UW Employees, Inc. Life Insurance plan offers decreasing term life insurance for employees only. Coverage is based on
age and ranges from $33,000-$7,000. You are eligible for this life insurance plan if you are eligible for State Group Health
Insurance. More information: hr.wisc.edu/benefits/uw-employees-inc-life-insurance

Available Coverage
Coverage is available for the employee only.
Employee/Employer Contribution

There is no employer contribution for UW Employees, Inc. Life Insurance. All plans premiums are paid through employee
contribution.

University Insurance Association Life Insurance
Plan Description

Participation in this decreasing term life insurance plan is mandatory for all eligible faculty, academic staff, and limited
employees. University staff are not eligible. Eligibility will be evaluated annually based on active employment informa-
tion as of October 1st to ensure that the employee meets the minimum salary requirements. Benefit level is based on
employee age at the beginning of the policy year (October 1).

The University Insurance Association (UIA) Life Insurance plan offers decreasing term life insurance to eligible Faculty,
Academic Staff, and Limited appointees. If you meet the monthly salary requirement, you will be automatically enrolled
in this plan. No application is required. Coverage ranges from $101,000 – $3,400 depending on employee age. UIA is
eligible for continuation at retirement at the group policy rate.
More information: hr.wisc.edu/benefits/university-insurance-association-life-insurance

Available Coverage
Coverage is available for the employee only.
Employee/Employer Contribution

There is no employer contribution for University Insurance Association Life Insurance. All plans premiums are paid
through employee contribution.

Premium

The annual premium of $24.00 is deducted from October earnings.

20 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Accidental Death and Dismemberment Insurance
Plan Description

The Accidental Death and Dismemberment Insurance plan (AD&D) protects you against losses resulting from a cov-
ered accident. You may select a coverage amount up to $500,000. If you enroll in family coverage, your dependents are
covered for a percentage of the benefit amount you select, subject to certain maximums. The plan also includes Zurich
Travel Assist® (a comprehensive travel assistance program that provides benefits and services when you are traveling 100
miles or more from your residence) and Identity Theft Protection.
More information: hr.wisc.edu/benefits/accidental-death-and-dismemberment-insurance

Available Coverage

Coverage is available for the employee, employee spouse or domestic partner and dependents.

Employee/Employer Contribution

There is no employer contribution for AD&D. All plans premiums are paid through employee contribution.

Enrollment and Effective Date of Coverage

You may enroll, change, or cancel at any time.

Coverage is effective on the first of the month following 30 days from the appointment start date.

Accident Insurance
Plan Description

Accident Insurance offers coverage in the case of an accident for you, your spouse, and/or eligible child(ren). The plan
provides a cash payment to help pay out-of-pocket expenses in the event of an accident. The plan also includes an acci-
dental death & dismemberment benefit.
More information: wisconsin.edu/ohrwd/benefits/life-accident/accident

Available Coverage

Coverage is available for the employee, employee spouse and dependents.

Employee/Employer Contribution

There is no employer contribution.

Premiums
2020

Monthly Premium
Employee

Employee +
Spouse

Employee +
Child(ren)

Family

Accident Insurance $3.26 $4.94 $7.10 $10.46

Enrollment and Effective Date of Coverage

You must apply within 30 days of your appointment start date.

Coverage is effective on the 1st of the month on or following your appointment start date.

212020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Flexible Spending Accounts
Plan Description

The Flexible Spending Accounts program allows you to set aside money on a pre-tax basis to pay for eligible medical and
dependent care expenses annually. You decide how much to set aside, and that amount is deducted from each paycheck
before federal, state and FICA taxes are calculated so you save money on taxes.

You may only change your annual election amount during the year if you have a life event change in status (e.g. marriage,
divorce, birth, leave of absence).

A Health Care FSA is used to pay for eligible medical expenses that aren’t covered by your insurance. Eligible expenses
include but are not limited to co-insurance, co-payments, dental costs and vision expenses (e.g. glasses, contacts, contact
solution). Most over-the-counter medications are not covered unless you have a prescription from your doctor. If you
participate in a High Deductible Health Plan you are only eligible for a Limited Purpose FSA for vision and dental expens-
es.

These expenses can be incurred by you, your spouse (same or opposite-sex spouse) and your qualifying child or relative.

You may contribute a minimum of $100 or up to $2,700 to your Health Care FSA. The 2020 plan year is from January 1,
2020–December 31, 2020. If you have unused monies left in your Healthcare or Limited Purpose FSA on December 31,
2020, up to $500 will carry over to the 2021 plan year. Anything over $500 will be lost.

A Dependent Day Care FSA is used to pay for eligible dependent care expenses such as after school care, baby-sitting
fees, adult or child daycare and preschool.

Eligible dependents include your qualifying child, spouse (same or opposite-sex spouse) and/or relative.

You may contribute a minimum of $100 or up to $5,000 into your Dependent Day Care FSA. Plan carefully; any money
remaining in your FSA account at the end of the plan year will be lost. For 2020 expenses, you have to incur charges by
December 31, 2020 and you will have until March 30, 2021 to submit the dependent day care expenses against 2020
balances.

Enrollment and Effective Date of Coverage
You must apply within 30 days of your appointment start date.

Coverage is effective on the 1st of the month on or following the appointment start date.

22 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Tax-Sheltered Annuity 403(b)
Plan Description

The UW Tax-Sheltered Annuity (TSA) 403(b) Program is a supplemental retirement savings program regulated by Section
403(b) of the Internal Revenue Code. Through the TSA Program you can invest a portion of your income for retirement
on either a pre-tax basis, an after-tax basis (Roth) or a combination of both. Participation in the UW TSA Plan is voluntary.

UW TSA 403(b) Program investment options include a wide array of mutual funds and fixed and variable annuities man-
aged by several investment companies:

• TIAA

• Fidelity

• T. Rowe Price

• Ameriprise/RiverSource Life Insurance

• Lincoln National Life Insurance

If you have 15 years or more of service with the UW and your TSA contributions average less than $5,000 per year over
the course of your UW employment, you may be eligible for catch-up contributions.

Available Coverage

Participation is available for the employee only.

Employee/Employer Contribution

You make the entire contribution; there is no employer match. University staff may contribute as little as $8 per pay-
check. Faculty, Academic Staff, and Limited employees may contribute as little as $20 per paycheck.

There is no enrollment deadline.

232020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Wisconsin Deferred Compensation 457(b)
Plan Description

The Wisconsin Deferred Compensation 457 (WDC) Program is a supplemental retirement savings plan, regulated by Sec-
tion 457 of the Internal Revenue Code. Through the WDC Program you can invest a portion of your income for retirement
on either a pre-tax basis, an after-tax basis (Roth) or a combination of both. Participation in the plan is voluntary.

WDC offers a wide range of investment options to meet your needs. The investment options are divided into 4 tiers:

• Lifecycle Funds

• Passive Index Funds

• Actively Managed Funds

• Self-Directed Brokerage Account

If you are within 3 years of your normal retirement age and you have under-contributed in the past, you may be eligible
for catch-up contributions.

Available Coverage
Participation is available for the employee only.
Employee/Employer Contribution

The employee makes the entire contribution; there is no employer match. There is no minimum monthly contribution.

Office of Human Resources
21 N. Park Street, Suite 5101

Madison, Wisconsin 53715-1218

Revised Jan 2020

Visit our YouTube channel!
UW–Madison Office of Human Resources

hr.wisc.edu/videos

24 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Welcome
to the University of Wisconsin–Madison

New Employee Benefits Summary | 2020
For employees covered by the Wisconsin Retirement System (WRS)

with appointment start dates between December 2, 2019–December 1, 2020

•

University Staff

• Academic Staff
• Faculty
• Limited Appointees

Office of Human Resources
21 N. Park Street, Suite 5101

Madison, Wisconsin 53715-1218

Walk-ins: 9 am–3 pm
(first-come, first-served)

INFORMATION IN DIFFERENT LANGUAGES

Welcome to the University of Wisconsin–Madison!

Visit our website for more information: hr.wisc.edu/benefits

If you have questions about your benefits, please contact UW–Madison Benefits Services
at benefits@ohr.wisc.edu or 608-262-5650.

Once again, welcome to UW–Madison.

On Wisconsin!

Benefits 101
Presentation for New Employees

For employees covered by the Wisconsin Retirement System (WRS)

Presented by: UW–Madison Office of Human Resources, Benefit Services

Welcome to the University of Wisconsin–Madison!

If you are a new employee, or an existing employee who is newly covered by the Wisconsin
Retirement System, register for this session within your first 30 days!

Features

Locations

Visit hr.wisc.edu/benefits for complete comprehensive benefits information.

If you have questions, contact benefits@ohr.wisc.edu.

21 N. Park Street, southeast campus areaUW–Madison, southeast overview map

This benefit summary is an overview of UW–Madison employee benefits. For more detailed information, applications,
guides, and booklets, visit hr.wisc.edu/benefits.

Table of Contents

52020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Coverage Deadlines and Effective Date of Coverage
Most benefit plans have a 30 day enrollment period from the start date of your appointment. Some plans have additional
requirements.

New Employee Resources
The resources listed below will help you review your benefits options and make informed choices. Please use these
resources that have been designed for you.

• Benefits Website
For detailed information about the benefit plans included in this summary, visit the UW–Madison Benefits Services
website: hr.wisc.edu/benefits

The Ask ALEX tool doesn’t answer everything. For additional information, contact benefits@ohr.wisc.edu with any
questions prior to enrolling in a new plan.

See your department HR Payroll & Benefits contact for help with the following, or visit the listed website:

• Pay schedules: hr.wisc.edu/pay

• Leave benefits: hr.wisc.edu/benefits/leave/paid-leave

• Transportation and parking: transportation.wisc.edu

6 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Wisconsin Retirement System
Plan Description

For detailed information about the WRS: hr.wisc.edu/benefits/wisconsin-retirement-system

Available Coverage

WRS participation is automatic for all eligible employees.

Employee/Employer Contribution

Contributions are taken on a pre-tax basis for federal and state income tax purposes. Contribution rates are set on an
annual basis by ETF.

72020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

State Group Health Insurance
Plan Description

You can choose between an IYC Health Plan (formerly known as Coinsurance Uniform Benefit plan) or a High

Deductible

Opt-Out Incentive

Available Coverage

Coverage is available for the employee, employee spouse and dependents.

Employee/Employer Contribution

2020 Premiums for WRS Covered Employees

State Group Health Insurance Plans
Medical With Dental Medical Without Dental

Single Family Single

Family

Health Plan $93.00 $231.00 $89.00 $222.00

HDHP $35.00 $87.00 $31.00 $78.00

Access Health Plan $273.00 $679.00 $269.00 $670.00

Access HDHP $215.00 $535.00 $211.00 $526.00

Access Health Plan (Tier 2*) $147.00 $367.00 $143.00 $358.00

Access HDHP (Tier 2*) $89.00 $223.00 $85.00 $214.00

*required to work out of state

NOTE: Employees working below 50% time (and LTEs with one appointment) must pay 50% of the
entire premium for their health plan.

8 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Comparison of Benefit Options

Enrollment and Effective Date of Coverage

You must apply within 30 days of your appointment start date.

Coverage is effective the first of the month on or following your appointment, as long as your application is received
within 30 days.

Examples:

Any employee not electing to enroll in State Group Health insurance coverage must submit an application to decline
coverage.

92020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

2020 State – Comparison of Benefits Options

Benefit Health Plan
Access Plan

In-Network Out-of-Network

Annual Medical
Deductible

$250 individual /
$500 family

Deductible applies to
annual OOPL

After an individual
within a family plan
meets the $250
deductible, coinsurance
will apply to covered
medical services except
for office visit
copayments

Medical deductible does
not apply to prescription
drugs

$500 individual /
$1,000 family

Deductible applies to
annual OOPL

After an individual
within a family plan
meets the $500
deductible, coinsurance
will apply to covered
medical services except
for office visit
copayments

Medical deductible does
not apply to prescription
drugs

Primary Care Physician
Office Visit Copayment
includes:

$15 per visit

Office visit copayments
are not subject to the
deductible, but do apply
to the annual OOPL

$15 per visit
Office visit copayments
are not subject to the
deductible, but do apply
to the annual OOPL

After deductible: 30%
member cost up to the
annual OOPL

Specialty Office Visit
Copayment includes:

• Specialty Providers
• Urgent Care
• Vision Exam in an
office visit setting

$25 per visit

10 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Annual Medical
Coinsurance

After deductible: 10%
member cost

Applies to medical
services except for
office visits

Coinsurance applies to
the annual OOPL

After deductible: 10%
member cost
Applies to medical
services except for
office visits
Coinsurance applies to
the annual OOPL

After deductible: 30%
member cost

Applies to medical
services

Coinsurance applies to
the annual OOPL

Annual Medical Out-of-
Pocket Limit (OOPL)

$1,250 individual /
$2,500 family

$2,000 individual /
$4,000 family

Routine, preventive
services as required by
federal law

Plan pays 100% Plan pays 100%
Subject to the
deductible, copayments
and/or coinsurance

Illness/injury related
services beyond the
office visit copayment (if
applicable)

After deductible: 10%
member cost up to
OOPL

After deductible: 10%
member cost up to the
annual OOPL

After deductible: 30%
member cost up to the
annual OOPL

Emergency Room
Copayment (Waived if
admitted as an inpatient
directly from the
emergency room or for
observation for 24
hours or longer.)

$75 copayment per
visit, then the deductible
and coinsurance
applies to services
beyond the copayment
up to the OOPL

$75 copayment per
visit, then in-network
deductible and
coinsurance applies to
services beyond the
copayment up to the
OOPL

112020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

2020 State – Comparison of Benefits Options for Prescription Drugs

Drug Level Health Plan
Access Plan

In-Network Out-of-Network

Deductible

None None

Copayment / Coinsurance

Level 1 $5 $5

Level 2 20% ($50 max) 20% ($50 max)

Level 3

If you have a medical need and cannot
take the generic equivalent, your M.D.

must submit an FDA MedWatch form to
Navitus for the prescription. With the form,
you pay a 40% coinsurance (with a limit of

$150). Without the form, you pay 40%
plus the cost difference between the

brand name drug and its generic
equivalent. Contact Navitus for details.

Level 4
Preferred

$50
Must fill at Lumicera or

UW Health Specialty Pharmacy

$50
Must fill at Lumicera or
UW Health Specialty Pharmacy

Out-of-Pocket Limits

Levels 1 & 2 $600 / $1,200 $600 / $1,200

Level 3 $6,850 / $13,700 $6,850 / $13,700
Must use

In-Network
pharmacy

Level 4 $1,200 / $2,400 $1,200 / $2,400

12 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

2020 State – Comparison of Benefits Options

Benefit HDHP
Access HDHP

In-Network Out-of-Network
Annual Medical
Deductible

$1,500 individual /
$3,000 family

The deductible must be
met before coverage
begins; for family
coverage, the full family
deductible must be met

The deductible includes
prescription drugs and
applies to the annual
OOPL

$1,500 individual /
$3,000 family

The deductible must be
met before coverage
begins; for family
coverage, the full family
deductible must be met

The deductible does
apply to prescription
drugs and also to the
annual OOPL

$2,000 individual /
$4,000 family
The deductible must be
met before coverage
begins; for family
coverage, the full family
deductible must be met

The deductible includes
prescription drugs and
applies to OOPL

After deductible: $15
per visit

Office visit copayments
apply to the annual
OOPL

After deductible: $15
per visit

Office visit copayments
do apply to the annual
OOPL

After deductible: 30%
member cost up to the
annual OOPL

Specialty Office Visit
Copayment includes:
• Specialty Providers
• Urgent Care
• Vision Exam in an
office visit setting

After deductible: $25
per visit

Office visit copayments
apply to the annual
OOPL
After deductible: $25
per visit
Office visit copayments
do apply to the annual
OOPL
After deductible: 30%
member cost up to the
annual OOPL

132020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Annual Medical
Coinsurance

After deductible: 10%
member cost

Applies to medical
services except for
office visits

Coinsurance applies to
the annual OOPL
After deductible: 10%
member cost
Applies to medical
services except for
office visits
Coinsurance applies to
the annual OOPL

After deductible: 30%
member cost

Applies to medical
services except for
office visits
Coinsurance applies to
the annual OOPL
Annual Medical Out-of-
Pocket Limit (OOPL)

$2,500 individual /
$5,000 family

$3,800 individual /
$7,600 family

Routine, preventive
services as required by
federal law

Plan pays 100% Plan pays 100%
Subject to the
deductible and
coinsurance

After deductible: $75
copayment per visit,
then coinsurance
applies to services
beyond the copayment
up to the OOPL

After deductible: $75
copayment per visit,
then the deductible and
coinsurance applies to
services beyond the
copayment up to the
OOPL

After deductible: $75
copayment per visit,
then in-network
deductible and
coinsurance applies to
services beyond the
copayment up to the
OOPL

14 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

152020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Delta Dental

Uniform Dental &
Preventive Plan Select Plan Select Plus Plan

In-Network providers
(No out-of-network coverage)

Delta Dental PPO &
Premier providers

Delta Dental PPO
Delta Dental PPO &
Premier providers

Annual deductible None $100 / person $25 / person

Annual benefit max $1,000 / person $1,000 / person $2,500 / person

Waiting period None None None

Routine evaluations, dental cleanings,
sealants, bitewing and panoramic
X-rays, fluoride treatments, pulp vitality
tests

100% No coverage No coverage

Fillings 100% No coverage No coverage

Anesthesia (general and IV sedation) 80% 50% 80%

Emergency pain relief 80% No coverage No coverage

Periodontal maintenance 100% No coverage No coverage

Crowns, bridges, dentures, implants No coverage 50% 60%

Surgical extraction, root canal
(endodontics), periodontics (except
maintenance), oral surgery

No coverage 50% 80%

Non-surgical extractions
(above gumline)

90% No coverage No coverage

Orthodontics coverage
50%

(Under age 19)
No coverage

50%
(Any age)

Orthodontics lifetime maximum $1,500 No coverage $1,500

What is Covered

Uniform Dental Preventive Plan Select Plan Select Plus Plan

Individual $4 $30.20 $9.28 $16.82

Individual + Child(ren) — — $12.52 $31.12

Individual + Spouse — — $18.56 $33.64

Family $9 $75.50 $22.28 $51.30

Monthly Cost (Premium)
The Uniform Dental premium is added to your health insurance premium. Preventive Plan, Select Plan and
Select Plus Plan are separate deductions.

16 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

VSP Vision
Plan Description

In-Network coverage includes:

• One well-vision exam per calendar year after $15 co-payment

• Coverage for glasses or contact lenses each year

o $150 retail frame allowance (or $200 retail frame allowance for featured frame brands) every other year
after $25 co-pay, lenses every year after $25 co-pay

o $150 contact lens allowance per year with co-pay up to $40

• There is no charge for standard progressive lenses.

• Discounts may be available on services not covered by the plan, such as additional glasses, laser vision correc-
tion, and some services/materials.

• KidsCare Program – allows two exams per year, impact resistant lenses, lenses replaced as needed, frames
replaced annually with $25 co-pay

Available Coverage
Coverage is available for the employee, employee spouse and dependents.
Employee/Employer Contribution

There is no employer contribution.

Premiums

2020
Monthly

Premium

Employee
Employee +
Spouse/DP

Employee +
Child(ren)*

Family

VSP $6.38 $12.76 $14.38 $22.98

Enrollment and Effective Date of Coverage

You must apply within 30 days of your appointment start date.

Coverage is effective the first of the month on or following your appointment, as long as your enrollment is received
within 30 days.

Examples:

• If you are hired on January 1, and your enrollment is received by January 31, coverage is effective on January 1.

• If you are hired on any day of the month after the 1st, and your enrollment is received within 30 days, coverage is
effective the first of the month following your date of hire.

172020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Income Continuation Insurance
Plan Description

Available Coverage

Coverage is available for the employee only.

Employee/Employer Contribution

ICI premiums are paid through a combination of employer and employee contributions. When coverage is elected deter-
mines the coverage option and the amount of employer and employee contributions.

Enrollment and Effective Date of Coverage

Faculty/Academic Staff/Limited Staff

University Staff

You must apply within 30 days of your appointment start date. Coverage is effective on the 1st of the month on or fol-
lowing the date of hire.

All employees must be under age 70 to be eligible. Any employee not electing to enroll in ICI must submit an enrollment
to decline coverage.

18 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Life Insurance Plans
The University offers life insurance coverage through several different plans.

Plan descriptions for the life insurance plans available to you are listed on the following pages. Comparison charts high-
lighting the features: wisconsin.edu/ohrwd/benefits/download/life/lifecomp

Life Insurance Premiums

Premiums for all life insurance plans are available here: wisconsin.edu/ohrwd/benefits/premiums/#life

State Group Life Insurance
Plan Description

Available Coverage
Coverage is available for the employee, employee spouse and dependents.
Employee/Employer Contribution

SGL Insurance premiums are paid through a combination of employer and employee contributions

Enrollment and Effective Date of Coverage
You must apply within 30 days of your appointment start date.

Coverage is effective on the first of the month following 30 days from the appointment start date.

If you elect to not enroll in State Group Life insurance, you must submit an enrollment to decline coverage.

Individual and Family Group Life Insurance
Plan Description

Available Coverage

Coverage is available for the employee, employee spouse or domestic partner and dependents.

192020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

UW Employees, Inc. Life Insurance
Plan Description

Available Coverage
Coverage is available for the employee only.
Employee/Employer Contribution

There is no employer contribution for UW Employees, Inc. Life Insurance. All plans premiums are paid through employee
contribution.

University Insurance Association Life Insurance
Plan Description

Available Coverage
Coverage is available for the employee only.
Employee/Employer Contribution

There is no employer contribution for University Insurance Association Life Insurance. All plans premiums are paid
through employee contribution.

Premium

The annual premium of $24.00 is deducted from October earnings.

20 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Accidental Death and Dismemberment Insurance
Plan Description

Available Coverage

Coverage is available for the employee, employee spouse or domestic partner and dependents.

Employee/Employer Contribution

There is no employer contribution for AD&D. All plans premiums are paid through employee contribution.

Enrollment and Effective Date of Coverage

You may enroll, change, or cancel at any time.

Coverage is effective on the first of the month following 30 days from the appointment start date.

Accident Insurance
Plan Description

Available Coverage

Coverage is available for the employee, employee spouse and dependents.

Employee/Employer Contribution

There is no employer contribution.

Premiums
2020

Monthly Premium
Employee

Employee +
Spouse

Employee +
Child(ren)

Family

Accident Insurance $3.26 $4.94 $7.10 $10.46

Enrollment and Effective Date of Coverage

You must apply within 30 days of your appointment start date.

Coverage is effective on the 1st of the month on or following your appointment start date.

212020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Flexible Spending Accounts
Plan Description

You may only change your annual election amount during the year if you have a life event change in status (e.g. marriage,
divorce, birth, leave of absence).

These expenses can be incurred by you, your spouse (same or opposite-sex spouse) and your qualifying child or relative.

A Dependent Day Care FSA is used to pay for eligible dependent care expenses such as after school care, baby-sitting
fees, adult or child daycare and preschool.

Eligible dependents include your qualifying child, spouse (same or opposite-sex spouse) and/or relative.

Enrollment and Effective Date of Coverage
You must apply within 30 days of your appointment start date.

Coverage is effective on the 1st of the month on or following the appointment start date.

22 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Tax-Sheltered Annuity 403(b)
Plan Description

UW TSA 403(b) Program investment options include a wide array of mutual funds and fixed and variable annuities man-
aged by several investment companies:

• TIAA

• Fidelity

• T. Rowe Price

• Ameriprise/RiverSource Life Insurance

• Lincoln National Life Insurance

If you have 15 years or more of service with the UW and your TSA contributions average less than $5,000 per year over
the course of your UW employment, you may be eligible for catch-up contributions.

Available Coverage

Participation is available for the employee only.

Employee/Employer Contribution

There is no enrollment deadline.

232020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Wisconsin Deferred Compensation 457(b)
Plan Description

WDC offers a wide range of investment options to meet your needs. The investment options are divided into 4 tiers:

• Lifecycle Funds

• Passive Index Funds

• Actively Managed Funds

• Self-Directed Brokerage Account

If you are within 3 years of your normal retirement age and you have under-contributed in the past, you may be eligible
for catch-up contributions.

Available Coverage
Participation is available for the employee only.
Employee/Employer Contribution

The employee makes the entire contribution; there is no employer match. There is no minimum monthly contribution.

Office of Human Resources
21 N. Park Street, Suite 5101

Madison, Wisconsin 53715-1218

Revised Jan 2020

Visit our YouTube channel!
UW–Madison Office of Human Resources

hr.wisc.edu/videos

24 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Welcome
to the University of Wisconsin–Madison

New Employee Benefits Summary | 2020
For employees covered by the Wisconsin Retirement System (WRS)

with appointment start dates between December 2, 2019–December 1, 2020

•

University Staff

• Academic Staff
• Faculty
• Limited Appointees

Office of Human Resources
21 N. Park Street, Suite 5101

Madison, Wisconsin 53715-1218

Walk-ins: 9 am–3 pm
(first-come, first-served)

INFORMATION IN DIFFERENT LANGUAGES

Welcome to the University of Wisconsin–Madison!

Visit our website for more information: hr.wisc.edu/benefits

If you have questions about your benefits, please contact UW–Madison Benefits Services
at benefits@ohr.wisc.edu or 608-262-5650.

Once again, welcome to UW–Madison.

On Wisconsin!

Benefits 101
Presentation for New Employees

For employees covered by the Wisconsin Retirement System (WRS)

Presented by: UW–Madison Office of Human Resources, Benefit Services

Welcome to the University of Wisconsin–Madison!

If you are a new employee, or an existing employee who is newly covered by the Wisconsin
Retirement System, register for this session within your first 30 days!

Features

Locations

Visit hr.wisc.edu/benefits for complete comprehensive benefits information.

If you have questions, contact benefits@ohr.wisc.edu.

21 N. Park Street, southeast campus areaUW–Madison, southeast overview map

This benefit summary is an overview of UW–Madison employee benefits. For more detailed information, applications,
guides, and booklets, visit hr.wisc.edu/benefits.

Table of Contents

52020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Coverage Deadlines and Effective Date of Coverage
Most benefit plans have a 30 day enrollment period from the start date of your appointment. Some plans have additional
requirements.

New Employee Resources
The resources listed below will help you review your benefits options and make informed choices. Please use these
resources that have been designed for you.

• Benefits Website
For detailed information about the benefit plans included in this summary, visit the UW–Madison Benefits Services
website: hr.wisc.edu/benefits

The Ask ALEX tool doesn’t answer everything. For additional information, contact benefits@ohr.wisc.edu with any
questions prior to enrolling in a new plan.

See your department HR Payroll & Benefits contact for help with the following, or visit the listed website:

• Pay schedules: hr.wisc.edu/pay

• Leave benefits: hr.wisc.edu/benefits/leave/paid-leave

• Transportation and parking: transportation.wisc.edu

6 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Wisconsin Retirement System
Plan Description

For detailed information about the WRS: hr.wisc.edu/benefits/wisconsin-retirement-system

Available Coverage

WRS participation is automatic for all eligible employees.

Employee/Employer Contribution

Contributions are taken on a pre-tax basis for federal and state income tax purposes. Contribution rates are set on an
annual basis by ETF.

72020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

State Group Health Insurance
Plan Description

You can choose between an IYC Health Plan (formerly known as Coinsurance Uniform Benefit plan) or a High

Deductible

Opt-Out Incentive

Available Coverage

Coverage is available for the employee, employee spouse and dependents.

Employee/Employer Contribution

2020 Premiums for WRS Covered Employees

State Group Health Insurance Plans
Medical With Dental Medical Without Dental

Single Family Single

Family

Health Plan $93.00 $231.00 $89.00 $222.00

HDHP $35.00 $87.00 $31.00 $78.00

Access Health Plan $273.00 $679.00 $269.00 $670.00

Access HDHP $215.00 $535.00 $211.00 $526.00

Access Health Plan (Tier 2*) $147.00 $367.00 $143.00 $358.00

Access HDHP (Tier 2*) $89.00 $223.00 $85.00 $214.00

*required to work out of state

NOTE: Employees working below 50% time (and LTEs with one appointment) must pay 50% of the
entire premium for their health plan.

8 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Comparison of Benefit Options

Enrollment and Effective Date of Coverage

You must apply within 30 days of your appointment start date.

Coverage is effective the first of the month on or following your appointment, as long as your application is received
within 30 days.

Examples:

Any employee not electing to enroll in State Group Health insurance coverage must submit an application to decline
coverage.

92020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

2020 State – Comparison of Benefits Options

Benefit Health Plan
Access Plan

In-Network Out-of-Network

Annual Medical
Deductible

$250 individual /
$500 family

Deductible applies to
annual OOPL

After an individual
within a family plan
meets the $250
deductible, coinsurance
will apply to covered
medical services except
for office visit
copayments

Medical deductible does
not apply to prescription
drugs

$500 individual /
$1,000 family

Deductible applies to
annual OOPL

After an individual
within a family plan
meets the $500
deductible, coinsurance
will apply to covered
medical services except
for office visit
copayments

Medical deductible does
not apply to prescription
drugs

Primary Care Physician
Office Visit Copayment
includes:

$15 per visit

Office visit copayments
are not subject to the
deductible, but do apply
to the annual OOPL

$15 per visit
Office visit copayments
are not subject to the
deductible, but do apply
to the annual OOPL

After deductible: 30%
member cost up to the
annual OOPL

Specialty Office Visit
Copayment includes:

• Specialty Providers
• Urgent Care
• Vision Exam in an
office visit setting

$25 per visit

10 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Annual Medical
Coinsurance

After deductible: 10%
member cost

Applies to medical
services except for
office visits

Coinsurance applies to
the annual OOPL

After deductible: 10%
member cost
Applies to medical
services except for
office visits
Coinsurance applies to
the annual OOPL

After deductible: 30%
member cost

Applies to medical
services

Coinsurance applies to
the annual OOPL

Annual Medical Out-of-
Pocket Limit (OOPL)

$1,250 individual /
$2,500 family

$2,000 individual /
$4,000 family

Routine, preventive
services as required by
federal law

Plan pays 100% Plan pays 100%
Subject to the
deductible, copayments
and/or coinsurance

Illness/injury related
services beyond the
office visit copayment (if
applicable)

After deductible: 10%
member cost up to
OOPL

After deductible: 10%
member cost up to the
annual OOPL

After deductible: 30%
member cost up to the
annual OOPL

Emergency Room
Copayment (Waived if
admitted as an inpatient
directly from the
emergency room or for
observation for 24
hours or longer.)

$75 copayment per
visit, then the deductible
and coinsurance
applies to services
beyond the copayment
up to the OOPL

$75 copayment per
visit, then in-network
deductible and
coinsurance applies to
services beyond the
copayment up to the
OOPL

112020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

2020 State – Comparison of Benefits Options for Prescription Drugs

Drug Level Health Plan
Access Plan

In-Network Out-of-Network

Deductible

None None

Copayment / Coinsurance

Level 1 $5 $5

Level 2 20% ($50 max) 20% ($50 max)

Level 3

If you have a medical need and cannot
take the generic equivalent, your M.D.

must submit an FDA MedWatch form to
Navitus for the prescription. With the form,
you pay a 40% coinsurance (with a limit of

$150). Without the form, you pay 40%
plus the cost difference between the

brand name drug and its generic
equivalent. Contact Navitus for details.

Level 4
Preferred

$50
Must fill at Lumicera or

UW Health Specialty Pharmacy

$50
Must fill at Lumicera or
UW Health Specialty Pharmacy

Out-of-Pocket Limits

Levels 1 & 2 $600 / $1,200 $600 / $1,200

Level 3 $6,850 / $13,700 $6,850 / $13,700
Must use

In-Network
pharmacy

Level 4 $1,200 / $2,400 $1,200 / $2,400

12 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

2020 State – Comparison of Benefits Options

Benefit HDHP
Access HDHP

In-Network Out-of-Network
Annual Medical
Deductible

$1,500 individual /
$3,000 family

The deductible must be
met before coverage
begins; for family
coverage, the full family
deductible must be met

The deductible includes
prescription drugs and
applies to the annual
OOPL

$1,500 individual /
$3,000 family

The deductible must be
met before coverage
begins; for family
coverage, the full family
deductible must be met

The deductible does
apply to prescription
drugs and also to the
annual OOPL

$2,000 individual /
$4,000 family
The deductible must be
met before coverage
begins; for family
coverage, the full family
deductible must be met

The deductible includes
prescription drugs and
applies to OOPL

After deductible: $15
per visit

Office visit copayments
apply to the annual
OOPL

After deductible: $15
per visit

Office visit copayments
do apply to the annual
OOPL

After deductible: 30%
member cost up to the
annual OOPL

Specialty Office Visit
Copayment includes:
• Specialty Providers
• Urgent Care
• Vision Exam in an
office visit setting

After deductible: $25
per visit

Office visit copayments
apply to the annual
OOPL
After deductible: $25
per visit
Office visit copayments
do apply to the annual
OOPL
After deductible: 30%
member cost up to the
annual OOPL

132020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Annual Medical
Coinsurance

After deductible: 10%
member cost

Applies to medical
services except for
office visits

Coinsurance applies to
the annual OOPL
After deductible: 10%
member cost
Applies to medical
services except for
office visits
Coinsurance applies to
the annual OOPL

After deductible: 30%
member cost

Applies to medical
services except for
office visits
Coinsurance applies to
the annual OOPL
Annual Medical Out-of-
Pocket Limit (OOPL)

$2,500 individual /
$5,000 family

$3,800 individual /
$7,600 family

Routine, preventive
services as required by
federal law

Plan pays 100% Plan pays 100%
Subject to the
deductible and
coinsurance

After deductible: $75
copayment per visit,
then coinsurance
applies to services
beyond the copayment
up to the OOPL

After deductible: $75
copayment per visit,
then the deductible and
coinsurance applies to
services beyond the
copayment up to the
OOPL

After deductible: $75
copayment per visit,
then in-network
deductible and
coinsurance applies to
services beyond the
copayment up to the
OOPL

14 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

152020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Delta Dental

Uniform Dental &
Preventive Plan Select Plan Select Plus Plan

In-Network providers
(No out-of-network coverage)

Delta Dental PPO &
Premier providers

Delta Dental PPO
Delta Dental PPO &
Premier providers

Annual deductible None $100 / person $25 / person

Annual benefit max $1,000 / person $1,000 / person $2,500 / person

Waiting period None None None

Routine evaluations, dental cleanings,
sealants, bitewing and panoramic
X-rays, fluoride treatments, pulp vitality
tests

100% No coverage No coverage

Fillings 100% No coverage No coverage

Anesthesia (general and IV sedation) 80% 50% 80%

Emergency pain relief 80% No coverage No coverage

Periodontal maintenance 100% No coverage No coverage

Crowns, bridges, dentures, implants No coverage 50% 60%

Surgical extraction, root canal
(endodontics), periodontics (except
maintenance), oral surgery

No coverage 50% 80%

Non-surgical extractions
(above gumline)

90% No coverage No coverage

Orthodontics coverage
50%

(Under age 19)
No coverage

50%
(Any age)

Orthodontics lifetime maximum $1,500 No coverage $1,500

What is Covered

Uniform Dental Preventive Plan Select Plan Select Plus Plan

Individual $4 $30.20 $9.28 $16.82

Individual + Child(ren) — — $12.52 $31.12

Individual + Spouse — — $18.56 $33.64

Family $9 $75.50 $22.28 $51.30

Monthly Cost (Premium)
The Uniform Dental premium is added to your health insurance premium. Preventive Plan, Select Plan and
Select Plus Plan are separate deductions.

16 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

VSP Vision
Plan Description

In-Network coverage includes:

• One well-vision exam per calendar year after $15 co-payment

• Coverage for glasses or contact lenses each year

o $150 retail frame allowance (or $200 retail frame allowance for featured frame brands) every other year
after $25 co-pay, lenses every year after $25 co-pay

o $150 contact lens allowance per year with co-pay up to $40

• There is no charge for standard progressive lenses.

• Discounts may be available on services not covered by the plan, such as additional glasses, laser vision correc-
tion, and some services/materials.

• KidsCare Program – allows two exams per year, impact resistant lenses, lenses replaced as needed, frames
replaced annually with $25 co-pay

Available Coverage
Coverage is available for the employee, employee spouse and dependents.
Employee/Employer Contribution

There is no employer contribution.

Premiums

2020
Monthly

Premium

Employee
Employee +
Spouse/DP

Employee +
Child(ren)*

Family

VSP $6.38 $12.76 $14.38 $22.98

Enrollment and Effective Date of Coverage

You must apply within 30 days of your appointment start date.

Coverage is effective the first of the month on or following your appointment, as long as your enrollment is received
within 30 days.

Examples:

• If you are hired on January 1, and your enrollment is received by January 31, coverage is effective on January 1.

• If you are hired on any day of the month after the 1st, and your enrollment is received within 30 days, coverage is
effective the first of the month following your date of hire.

172020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Income Continuation Insurance
Plan Description

Available Coverage

Coverage is available for the employee only.

Employee/Employer Contribution

ICI premiums are paid through a combination of employer and employee contributions. When coverage is elected deter-
mines the coverage option and the amount of employer and employee contributions.

Enrollment and Effective Date of Coverage

Faculty/Academic Staff/Limited Staff

University Staff

You must apply within 30 days of your appointment start date. Coverage is effective on the 1st of the month on or fol-
lowing the date of hire.

All employees must be under age 70 to be eligible. Any employee not electing to enroll in ICI must submit an enrollment
to decline coverage.

18 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Life Insurance Plans
The University offers life insurance coverage through several different plans.

Plan descriptions for the life insurance plans available to you are listed on the following pages. Comparison charts high-
lighting the features: wisconsin.edu/ohrwd/benefits/download/life/lifecomp

Life Insurance Premiums

Premiums for all life insurance plans are available here: wisconsin.edu/ohrwd/benefits/premiums/#life

State Group Life Insurance
Plan Description

Available Coverage
Coverage is available for the employee, employee spouse and dependents.
Employee/Employer Contribution

SGL Insurance premiums are paid through a combination of employer and employee contributions

Enrollment and Effective Date of Coverage
You must apply within 30 days of your appointment start date.

Coverage is effective on the first of the month following 30 days from the appointment start date.

If you elect to not enroll in State Group Life insurance, you must submit an enrollment to decline coverage.

Individual and Family Group Life Insurance
Plan Description

Available Coverage

Coverage is available for the employee, employee spouse or domestic partner and dependents.

192020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

UW Employees, Inc. Life Insurance
Plan Description

Available Coverage
Coverage is available for the employee only.
Employee/Employer Contribution

There is no employer contribution for UW Employees, Inc. Life Insurance. All plans premiums are paid through employee
contribution.

University Insurance Association Life Insurance
Plan Description

Available Coverage
Coverage is available for the employee only.
Employee/Employer Contribution

There is no employer contribution for University Insurance Association Life Insurance. All plans premiums are paid
through employee contribution.

Premium

The annual premium of $24.00 is deducted from October earnings.

20 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Accidental Death and Dismemberment Insurance
Plan Description

Available Coverage

Coverage is available for the employee, employee spouse or domestic partner and dependents.

Employee/Employer Contribution

There is no employer contribution for AD&D. All plans premiums are paid through employee contribution.

Enrollment and Effective Date of Coverage

You may enroll, change, or cancel at any time.

Coverage is effective on the first of the month following 30 days from the appointment start date.

Accident Insurance
Plan Description

Available Coverage

Coverage is available for the employee, employee spouse and dependents.

Employee/Employer Contribution

There is no employer contribution.

Premiums
2020

Monthly Premium
Employee

Employee +
Spouse

Employee +
Child(ren)

Family

Accident Insurance $3.26 $4.94 $7.10 $10.46

Enrollment and Effective Date of Coverage

You must apply within 30 days of your appointment start date.

Coverage is effective on the 1st of the month on or following your appointment start date.

212020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Flexible Spending Accounts
Plan Description

You may only change your annual election amount during the year if you have a life event change in status (e.g. marriage,
divorce, birth, leave of absence).

These expenses can be incurred by you, your spouse (same or opposite-sex spouse) and your qualifying child or relative.

A Dependent Day Care FSA is used to pay for eligible dependent care expenses such as after school care, baby-sitting
fees, adult or child daycare and preschool.

Eligible dependents include your qualifying child, spouse (same or opposite-sex spouse) and/or relative.

Enrollment and Effective Date of Coverage
You must apply within 30 days of your appointment start date.

Coverage is effective on the 1st of the month on or following the appointment start date.

22 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

Tax-Sheltered Annuity 403(b)
Plan Description

UW TSA 403(b) Program investment options include a wide array of mutual funds and fixed and variable annuities man-
aged by several investment companies:

• TIAA

• Fidelity

• T. Rowe Price

• Ameriprise/RiverSource Life Insurance

• Lincoln National Life Insurance

If you have 15 years or more of service with the UW and your TSA contributions average less than $5,000 per year over
the course of your UW employment, you may be eligible for catch-up contributions.

Available Coverage

Participation is available for the employee only.

Employee/Employer Contribution

There is no enrollment deadline.

232020 Benefits SummaryUW–Madison Benefits Services | hr.wisc.edu/benefits

Wisconsin Deferred Compensation 457(b)
Plan Description

WDC offers a wide range of investment options to meet your needs. The investment options are divided into 4 tiers:

• Lifecycle Funds

• Passive Index Funds

• Actively Managed Funds

• Self-Directed Brokerage Account

If you are within 3 years of your normal retirement age and you have under-contributed in the past, you may be eligible
for catch-up contributions.

Available Coverage
Participation is available for the employee only.
Employee/Employer Contribution

The employee makes the entire contribution; there is no employer match. There is no minimum monthly contribution.

Office of Human Resources
21 N. Park Street, Suite 5101

Madison, Wisconsin 53715-1218

Revised Jan 2020

Visit our YouTube channel!
UW–Madison Office of Human Resources

hr.wisc.edu/videos

24 2020 Benefits Summary UW–Madison Benefits Services | hr.wisc.edu/benefits

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