2015 Benefit Materials – Non-Represented Regular Employees

BENEFITS
2015 Benefit Materials – Non-Represented Regular Employees
Save in your “favorites” for easy access to information regarding UWHC Benefits
This document contains information for each benefit plan including enrollment opportunities, 2015 plan changes, plan
materials, and premiums. If you have questions regarding your benefits or the information contained in this document, please
contact Human Resources – Benefits at [email protected] or stop by one of the Employee Benefit Drop-In Sessions.
Index: Click on the links below to take you to that section of the document
1. Employee Self Service – Benefit Summary
2. Health Insurance
3. Supplemental Delta Dental
4. EPIC Benefits+
5. VSP Vision Care
6. Employee Reimbursement Accounts (ERA)
7. Health Savings Account (HSA)
8. Wisconsin Retirement System (WRS)
9. State Group Life Insurance (SGL)
10. Accidental Death & Dismemberment (AD&D)
11. UW Employees Inc. Life Insurance
12. Supplemental Life Insurance
13. Income Continuation Insurance (ICI)
14. Tax-Sheltered Annuity (TSA/403b)
15. Wisconsin Deferred Compensation (WDC/457)
16. Domestic Partner and Same-Sex Marriage
(links to external documents)
17. Employee Programs: Backup Care, Care.com, EAP
(links to external document)
EMPLOYEE SELF SERVICE – BENEFITS SUMMARY
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It is beneficial to review your current benefit enrollments prior to reading the 2015 benefit materials so you can focus on
information that is important to you. As a reminder, you may view your benefit enrollments at any time.
To access your Benefits Summary go to Employee Self Service. If you would like to view your Benefits Summary from home
visit www.uwhealth.org/homeaccess. Use your network username and password to log in and select Self Service, Benefits,
and Benefits Summary. To keep your personal information secure, always remember to log out after viewing any self-service
transaction.
HEALTH INSURANCE
Enrollment
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The It’s Your Choice open enrollment period is October 6 - 31, 2014.
If you do not want to make changes to your health insurance, no action is necessary.



Plan Materials

The It’s Your Choice health insurance materials are being distributed electronically again this year
and can be found on ETF’s Group Health Insurance page.
The 2015 Decision Guide provides key information that will assist you in choosing a health plan.
The 2015 Reference Guide contains technical information such as the full certificate of coverage
and required federal notifications.
The Health Insurance Application/Change form is required for enrollment and all changes.
If you would like hard copies of the books, please pick them up in Human Resources, stop by one of the
Employee Benefit Drop-In Sessions, or email [email protected].
Enroll in or Make
Changes to Your
Health Insurance
The annual It’s Your Choice period allows employees the opportunity to enroll in or make changes to
their health insurance without having a qualifying event. All enrollments and changes will be effective
January 1, 2015 provided a Health Insurance Application/Change form is completed and submitted to
Human Resources – Benefits between October 6 - 31, 2014.
Open Enrollment: You can enroll in health insurance with no restrictions during the It’s Your Choice
period, even if you do not currently have coverage.
Add/Remove Your Adult Children: You can add or remove your adult child(ren), ages 19-26, with no
restrictions. Please note that a change in student status is no longer considered a qualifying event for
mid-year changes.
Add/Remove Your Domestic Partner (which could include your same-sex spouse): You can add or
remove your domestic partner and his/her eligible children. In order to add a domestic partner and
his/her eligible children, you must file a domestic partnership affidavit with ETF. Please refer to the
Domestic Partner and/or the Same-Sex Marriage Information sheets for details and possible tax
implications.
Change Your Coverage Level: You can change from single to family or family to single coverage with no
restrictions.
Change Your Health Plan: You can change your health plan with no restrictions. This includes changing
health plan providers as well as changing from the Coinsurance Uniform (current plan) to the new High
Deductible Health Plan (HDHP).
Unity UW Health
Insurance
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Learn more at Unity Health.
2015 Plan
Changes
There are no changes to the benefits offered by the Coinsurance Uniform Benefit (current) health
insurance plan for 2015. If you are satisfied with your current health insurance coverage, you do not
have to do anything to continue your coverage in 2015.
HDHP/HSA
1. NEW OPTION: In addition to the Coinsurance Uniform Benefit (current) plan, each health plan will
now also offer a High Deductible Health Plan (HDHP) option.
 HDHPs have a minimum annual deductible and a maximum annual out-of-pocket limit (see
chart below).
 A HDHP begins to pay for health care costs after the annual deductible has been met. Except
as required by federal law, the health plan will not pay any medical, dental, or prescription
drug costs until your annual deductible has been met.
 Once you meet the annual deductible under the HDHP, you will pay a 10% coinsurance on
covered medical services and applicable coinsurance on dental benefits and prescription
copays up to the annual out-of-pocket limit (OOPL) maximum. Please note that the annual
deductible is counted towards the annual OOPL.
 In 2015, the HDHP is only available to non-represented regular and temporary/per-diem
employees.
 You are NOT eligible for HDHP coverage if you or your covered dependents:
o Are enrolled in any other health plan, including Medicare, Tricare, or BadgerCare.
o
If you are a dependent of another person for tax purposes (for example, if your parents
can claim you on their taxes).
o Are covered or will be covered under a Health Care Flexible Spending Account (FSA) in
2015. This includes a FSA enrollment through a spouse/domestic partner’s employer plan
and/or having funds left in your 2014 FSA after December 31, 2014. You cannot utilize the
FSA grace period (1/1/15-3/15/15) and be eligible for the HDHP in 2015.
For more information on this plan, please review the 2015 Decision Guide or visit ETF’s
HDHP/HSA page.

Who might be interested in enrolling in the HDHP/HSA?
 Risk Takers. Employees who think that their medical, prescription, and dental costs will be low
in 2015.
 Savers. Employees who can afford to pay the HDHP deductible if necessary and who want to
use the HSA as a savings/investment vehicle.
 Smart Budgeters. Employees who are attracted to the lower premium cost, but will put the
monthly premium savings into their HSA in the event the funds are needed to pay for
expenses that are applied to the HDHP deductible.
Before enrolling in a HDHP and the required HSA, be sure that you
understand the potential for higher out-of-pocket costs.
How is the HDHP different from the current Coinsurance Uniform Benefits?
 The High Deductible Health Plan has:
o A lower monthly premium.
o An annual deductible that must be met by the member(s) before any benefits are payable.
o You must enroll in a Health Savings Account (HSA) and receive an annual employer
contribution into the account if you select the HDHP. Please see the Health Savings
Account (HSA) section of this document for additional information.
o If you enroll in the HDHP and associated HSA, you are not eligible to enroll in the Health
Care FSA. You may still participate in the Dependent Day Care FSA and a Limited Purpose
FSA that offers reimbursement for vision, dental, and post-deductible medical expenses.
Please see the Employee Reimbursement Account section of this document for additional
information.
 There are other costs you should consider when comparing the Coinsurance Uniform Benefit
plan with the HDHP plan. Generally speaking, the lower your monthly premium, the more you
will pay in out-of-pocket costs including copayments, deductibles, and coinsurance. A
comparison of the costs is below. For a more detailed comparison of the two health insurance
options, please refer to Coinsurance Uniform Benefit/HDHP Comparison Chart.
Plan
Coinsurance
Uniform
Benefits
Coverage
Level
Annual
Deductible(2)
Annual
Medical
OOPL(1)
Annual Level 1
& 2 Prescription
Drugs OOPL(1)
Total
Annual
OOPL(1)
Monthly
Employee
Premium(3)
Single
$0
$500
$410
$910+(4)
$92
Family
$0
$1,000
$820
$1,820+(4)
$230
Single
$1,500
$2,500
$2,500
$32
Family
$3,000
$5,000
$5,000
$81
HDHP
(1)
(2)
(3)
(4)
Applies to
Medical OOPL
Applies to
Medical OOPL
OOPL = Out-of-Pocket Limit
The annual deductible is counted toward the annual OOPL.
Regular non-represented premiums for Tier 1 plans. All premiums are listed below.
Total OOPL could be higher if taking Level 3/4 prescription drugs since they do not count toward the annual OOPL.
2. Dependent Social Security Numbers Required:
Due to federal law, subscribers must provide Social Security numbers (SSN) for all dependents if
they have not already done so. Health plans and employers are required by the Patient Protection
and Affordable Care Act (PPACA) to report this information to the federal government in 2015. The
Benefits Department will contact you if you need to provide SSNs for your dependents. Please be
sure to submit your health insurance application within 30 days when adding a dependent even if
you do not yet have the SSN.
Dependent SSNs
Now Required
Wellness
Incentives
Taxable
3. Health Plan Issued Financial Incentives:
Internal Revenue Service (IRS) tax code considers financial reimbursements for wellness-related
expenses such as gym memberships, fitness classes, costs to participate in Community Supported
Agriculture, and rewards for participating in health or wellness programs or challenges to be fringe
benefits of employment. Therefore, they must be treated as a taxable wage subject to income and
payroll taxes. UWHC will receive financial data regarding incentives issued to employees and their
covered family members. This data will be included on your W2 at the end of the plan year for tax
purposes. Your health information is protected by federal privacy regulations and will not be
shared with UWHC. For more information, visit wellwisconsin.wi.gov.
4. Change to Dean Health Insurance and Dean Prevea 360:
Delta Dental will be the new dental provider for these health plans in 2015. Members will have
access to Premier and PPO Delta Dental networks. Members should verify if their current dental
provider(s) are in-network.
Dean’s Dental
Provider
Tiers: In 2015, all health plans will be assigned to Tier 1 with the exception of the WPS Standard Plan.
The Standard Plan will remain in Tier 3 (with the exception of out of state employees).
Premiums: The monthly employee health insurance premiums below will be effective in December
2014 for January 2015 coverage.
Eligible Non-Represented Full and Part-Time (50%+) Regular Employees
Insurance Type
Premiums
Coinsurance
Uniform Benefits
HDHP
Health Plan
HMOs
Tier 1
Standard Plan
Tier 3
HMOs
Tier 1
Standard Plan
Tier 3
Coverage Level
Single
Family
Single
Family
Single
Family
Single
Family
Non-Represented
$92
$230
$267
$666
$32
$81
$207
$517
Eligible Per Diem, LTE, Temporary, and Regular Employees working less than 50% will continue to pay
50% of the total monthly premium.
Supplemental Delta Dental
No Open Enrollment
2015 Plan Changes
Plan Materials
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There is no open enrollment for Delta Dental.
If you do not want to make changes to your dental insurance, no action is necessary.
There will be no benefit changes in 2015.
Please see the 2015 Supplemental Dental Benefit Summary or visit Delta Dental’s website for
complete plan information.
The monthly premiums remain the same for 2015:
Coverage Level
Employee only
Employee + 1 dependent
Employee + 2 or more dependents
Premiums
Premium
$20.92
$40.86
$64.54
Late Enrollment: A late enrollment is accepted throughout the year, but there is a 12-month
waiting period for Basic and Major Services and a 24-month waiting period for orthodontic
services. Late enrollment also applies to adding new dependents to your existing plan without
a qualifying event.
Cancel Coverage: If you wish to cancel coverage, submit an application to Human Resources Please note that coverage
Enroll or Make Changes Benefits by December 1, 2014 to be effective December 31, 2014.
st
cancellations received mid-year will be effective December 31 .
Remove Dependents: You may change from family to single coverage or remove dependents
from your plan at the end of any calendar year. If you wish to remove a dependent(s), submit
an application to Human Resources - Benefits by December 1, 2014 to be effective December
31, 2014.
EPIC BENEFITS+
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The EPIC Benefits+ special enrollment is October 6 – October 31, 2014.
If you are currently enrolled in EPIC Benefits+ coverage and do not wish to make changes, no action
is necessary.
Special Open
Enrollment
EPIC Benefits+ will offer a special enrollment opportunity with a tiered annual dental maximum for the
first two years you are enrolled. Any dependents added for 2015 will also be subject to the tiered
dental maximum according to the schedule below. There is a 24-month waiting period for orthodontic
services.
2015
$750


2015 Plan
Changes
Plan Materials
Premiums

Tiered Annual Dental Maximum Schedule
2016
2017
$1,000
$1,500 (full benefit)
There will be an increase in AD&D benefits by 50%.
The hospital indemnity benefit will increase from $100 to $200 per day (both inpatient and
outpatient benefits).
Enhanced benefits for optional vison materials
o Frames allowance will increase from $100 to $130 per year.
o Contact lens allowance will increase from $100 to $130 per year.
o The coverage level Employee + Child will change to Employee + Child(ren), allowing you to add
more than one child to this level of coverage.
Please review the EPIC Special Enrollment Brochure for a plan summary and more information. The
EPIC Benefits+ Enrollment Form is required for enrollment and all changes.
The monthly premiums remain the same for 2015:
Coverage Level
Employee Only
Employee + Spouse/Domestic Partner
Employee + Child (ren)
Family
Without Vision
$19.77
$39.54
$39.54
$59.31
With Vision
$24.02
$47.04
$47.04
$70.34
Enroll or Make
Changes
During the special enrollment period employees can enroll, add or remove dependents, add or remove
the vision insurance component, or cancel their coverage by completing the EPIC Benefits+ Enrollment
Form and submitting to Human Resources - Benefits between October 6 - 31, 2014.
A representative from EPIC will be available at all of the Employee Benefit Drop-In Sessions below to
answer any questions you may have, educate you on the plan, and assist you with making changes to
or enrolling in the plan.
Date
10/7/2014
10/9/2014
10/10/2014
10/16/2014
10/17/2014
10/23/2014
10/27/2014
EPIC Drop-In
Sessions
Time
10:30 am-1:30 pm
9:00 am-2:00 pm
10:30 am-1:30 pm
9:00 am-2:00 pm
6:30 am-1:00 pm
1:00 pm-6:00 pm
9:00 am-2:00 pm
Building
East Clinic
CSC
West Clinic
CSC
CSC
CSC
CSC
Room
L004
G5/152
1287-1288
G5/152
G5/152
G5/152
G5/152
VSP VISION CARE
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The VSP open enrollment is October 6 – October 31, 2014.
If you are already enrolled and do not want to make changes to your vision insurance, no action is
necessary.
Open Enrollment



2015 Plan Changes
There will be no benefit changes in 2015.
Plan Materials
This is an opportunity for employees to enroll in VSP that currently are not enrolled.
Any enrollments and changes submitted during the open enrollment will be effective Jan. 1, 2015.
You will not receive an insurance card. When receiving services, you should inform the
provider/merchant that you are covered by VSP insurance.
Please see the 2015 VSP Benefit Summary for complete plan information. To locate a VSP provider
please visit VSP at VSP provider.
The monthly premiums will change to the rates below in January 2015:
Premiums
Enroll or Make
Changes
Coverage Level
Employee Only
Employee + Spouse
Employee + Child(ren)
Family
2014
$6.35
$12.70
$14.30
$22.85
2015
$6.54
$13.08
$14.73
$23.54
During the open enrollment period, employees can enroll, add or remove dependents, or cancel
their existing coverage.
An application packet will be mailed to all eligible employees at their home address. Applications must
be submitted directly to VSP via mail, phone, or online at vsp.com/go/stateofwiemployees by October
31, 2014.
EMPLOYEE REIMBURSEMENT ACCOUNTS (ERA): FLEXIBLE SPENDING ACCOUNT (FSA)
Open Enrollment
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The ERA open enrollment is October 6 – October 31, 2014.
You need to newly enroll each year if you want to participate in this plan.
If you are enrolling for the HDHP/HSA, you may not enroll in the Health Care Flexible Spending
Account (FSA). You may enroll in the Dependent Day Care FSA and the new Limited Purpose FSA.
Benefits
The ERA program offers Flexible Spending Accounts (FSA) that allow you to pre-fund your anticipated,
eligible medical and dependent care expenses. You determine how much to set aside and that amount
is divided among each paycheck and deducted before Federal, State and FICA taxes are calculated so
you save money on taxes.
 The ERA program consists of three (3) options:
(1) A Health Care FSA is used to pay for eligible medical expenses that are not covered by your
insurance. These expenses can be incurred by you, your spouse (including same-sex spouse)
and your qualifying child or relative. You are not eligible for the Health Care FSA if you are
enrolled in the High Deductible Health Plan (HDHP) and associated Health Savings Account
(HSA).
(2) A Dependent Day Care FSA is used to pay for eligible dependent care expenses such as after
school care, babysitting fees, adult or child daycare, and preschool. Eligible dependents
include your qualifying child, spouse (including same-sex spouse), and/or qualifying relative.
(3) *NEW* - A Limited Purpose FSA (LPFSA) is used to pay for dental and vision expenses and
post-deductible expenses that are not covered by your health insurance. You must be enrolled
in the High Deductible Health Plan (HDHP) and associated Health Savings Account (HSA) to be
eligible for the LPFSA.
 To learn about how a FSA can save you and your family pre-tax savings annually, please access the
TASC Webcast.

Maximum annual IRS contribution limits are $5,000 for dependent day care and $2,500 for medical
expenses via the Health Care FSA or the LPFSA.
New Vendor:
 Total Administrative Services Corporation (TASC) will be the new ERA program administrator for
the Flexible Spending Accounts beginning January 1, 2015. TASC will handle ERA enrollment during
the 2015 It’s Your Choice benefit enrollment time period. See page 77 of the 2015 Decision Guide
for more information.
 TASC will also administer the Transit and Parking benefit for 2015. This is currently referred to as
the commuter benefit.
2015 Plan
Changes
New 2015 FSA Carryover:
 The plan year will be from January 1, 2015-December 31, 2015. There will be NO grace period
from January 1, 2016 - March 15, 2016. Expenses MUST be incurred between January 1, 2015December 31, 2015. You will have until April 15, 2016 to file your 2015 claims.
 If you have funds left in your FSA on December 31, 2015, you will be able to carry over the
maximum of $500 to the 2016 plan year. Anything over $500 will be forfeited.
New Limited Purpose FSA:
 The LPFSA is an option for those employees who elect the new High Deductible Health Plan
(HDHP) and associated Health Savings Account (HSA). Employees enrolled in the Coinsurance
Uniform Benefit health plan are NOT eligible for the LPFSA.
 A LPFSA is designed to work in conjunction with a HSA and can be used for vision, dental and postdeductible expenses only.
 In general, both the HSA and LPFSA allow for the same health care expenses and each type of
account has annual contribution limits. As a result, some participants who wish to use their HSA as
a savings/investment vehicle or who have high dental or vision expenses may be interested in
enrolling in the LPFSA on top of the required HSA.
 For additional information, please refer to the TASC LPFSA Flyer.
Plan Materials
For more information, review the documents on TASC’s Employee Documents page that include, How
to Enroll Online, an Enrollment Guide, Dependent Care Qualifications, FSA Eligible Expenses, and other
helpful information for after your account is established.
Enroll
You will enroll online directly with TASC at www.tasconline.com. Enter 4207-6195-4983 as the
Employer ID, enter your email address, and follow the prompts to establish your personal username
and password. You will receive a confirmation email from TASC. For assistance, please review How to
Enroll Online or call TASC directly at 608-241-1900 or 800-422-4661.
Reminder for
2014
TASC Debit Card
TASC Drop-In
Sessions
Important for 2014 FSA Participants: The 2014 plan year is from January 1, 2014 to March 15, 2015.
You have until March 15, 2015 to incur claims and until April 15, 2015 to submit claims. Any remaining
balance in your account after March 15, 2015 will be lost.
Please note that you are not eligible to participate in the HDHP and associated HSA in 2015 if you do
not use all of the funds in your 2014 Health Care FSA account by December 31, 2014 (you cannot
utilize the grace period).
You will receive a TASC Debit Card if you enroll for the Health Care FSA, Dependent Day Care FSA,
Limited Purpose FSA or Transit/Parking.
A representative from TASC will be available at the Employee Benefit Drop-In Sessions below to answer
questions you may have, educate you on their plans, and assist you with enrolling in the plan that is
appropriate for you and your corresponding health plan.
Date
10/10/2014
10/27/2014
Time
10:30 am-1:30 pm
9:00 am-2:00 pm
Building
West Clinic
CSC
Room
1287-1288
G5/152
HEALTH SAVINGS ACCOUNT (HSA)
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Open enrollment for HSA is October 6 – October 31, 2014.
Open Enrollment
You are required to establish a HSA if you elect the new High Deductible Health Plan (HDHP) option for
health insurance. If you elect the Coinsurance Uniform Benefit option for health insurance you are NOT
eligible to enroll in the HSA.
NEW: A Health Savings Account (HSA) is pre-tax savings account used to pay for eligible expenses such
as medical, dental, prescription and vision expenses – similar to a Health Care Flexible Spending
Account (FSA).


Benefits


If you enroll for a HDHP, you must also establish a HSA through the State of Wisconsin program.
You are NOT eligible to establish a HSA if:
o You are not enrolled in the HDHP option
o You can be claimed as a dependent on another person’s tax return
o You are enrolled in Medicare
o You are covered under another health plan that is not a High Deductible
o You are covered or will be covered under a Health Care FSA in 2015. This includes a FSA
enrollment through a spouse/domestic partner’s employer plan and/or having funds left in
your 2014 FSA after December 31, 2014. You cannot utilize the FSA grace period (1/1/153/15/15) and be eligible for the HDHP in 2015.
You may make tax-free contributions through payroll deduction (subject to annual limits) but are
not required to do so.
UWHC will also contribute to the HSA.
HDHP Coverage Level
Single
Family
Annual HSA Contribution Limits
UWHC Contribution
$170/year
$340/year
2015 Limit*
$3,350
$6,650
*The 2015 limit also includes the UWHC contribution. If you are 55-65 years of age, you may contribute an
additional $1,000 “catch-up” per year to your HSA.





The HSA is administered by Total Administrative Services Corporation (TASC).
The entire employer contribution is deposited to your account on the first paycheck of the year.
If you open your HSA after 1/1/15, your employer contribution will be prorated.
HSAs are owned by the individual. Balances roll over from year to year and the funds are portable,
meaning you keep them if you leave the HDHP plan or UWHC employment.
You can also choose to invest a portion of your HSA balance into a HSA investment account with
TASC.


You may change your amount of HSA contributions at any time. Please review the HSA Participant
Reference Guide for additional details.
You may only use the money once it is deposited into your account.
Plan Materials
For additional information, please refer to the HSA Participant Reference Guide and pages 7-11 of the
2015 Decision Guide.
Enroll
To enroll in a state-sponsored HSA, follow the instructions in the HSA Participant Reference Guide and
enroll online directly with TASC at TASC HSA Enrollment site and enter UWHC’s Client ID TASWI8789 as the “Code” under Setting up a New Account. Follow the prompts to create your
account. For assistance, call TASC directly at 608-245-3623 or 800-350-3778.
A representative from TASC will be available at the Employee Benefit Drop-In Sessions below to answer
questions you may have, educate you on their plans, and assist you with enrolling in the plan that is
appropriate for you and your corresponding health plan.
TASC Drop-In
Sessions
Date
10/10/2014
10/27/2014
Time
10:30 am-1:30 pm
9:00 am-2:00 pm
Building
West Clinic
CSC
Room
1287-1288
G5/152
WISCONSIN RETIREMENT SYSTEM (WRS)
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The WRS funding requirement for employee accounts in 2015 will decrease from 14.0% to 13.6%.
 The employee-required contribution will decrease from 7.0% to 6.8% for Non-Represented employees effective with
the check that will be received January 8, 2015.
 The 2015 Non-Represented WRS contribution rates are listed below:
Employee
6.8%
UWHC(1)
9.5%
Total(1)
16.3%
Invested
13.6%
(1)
The total WRS rates include the 2015 funding requirement plus 2.7% in other mandatory employer contributions for
the Accumulated Sick Leave Conversion Credit program and other unfunded liabilities.

WRS contributions are invested by the State of Wisconsin Investment Board (SWIB). For information on investments, see
the updated SWIB brochure, Investing For Your Retirement.

For the latest WRS information, please read the WRS News newsletter.

Please visit ETF’s new Member Education page to view educational videos and learn of face-to-face training and webinar
opportunities related to WRS and ETF-sponsored benefits. Opportunities are targeted based on where you are in your
career – New Employee, Mid-Career, and Nearing Retirement.

Please remember to keep your beneficiaries up to date. If you need to update your beneficiaries on file, please complete a
Beneficiary Designation Form and send it directly to ETF. Unless otherwise specified on the actual form, a Beneficiary
Designation Form submitted to ETF will apply to all accounts administered by ETF including the Wisconsin Retirement
System and State Group Life Insurance.

Contemplating retirement? ETF has a new, secure Online Retirement Estimate Request. You may still submit a paper copy
of the Retirement Estimate Request or call ETF Customer Service at 1-877-533-5020.
STATE GROUP LIFE (SGL) INSURANCE
No Open
Enrollment
2015 Plan
Changes
Plan Materials
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There is no open enrollment for State Group Life (SGL) insurance.
There are no plan changes for 2015.
For more information on SGL, please refer to the Wisconsin Public Employers Group Life Insurance
brochure or ETF’s website.


There will be no change to the Employee or Spouse/Dependent premiums.
Your premium is evaluated each year based on your current age and earnings from the previous
year. This premium update occurs in March for April coverage, and you will receive information
from Human Resources - Benefits regarding any change to your benefit or premium amount in
March 2015.


You may apply for SGL at any time throughout the year (your application will be subject to medical
underwriting) by submitting an evidence of insurability application directly to Minnesota Life.
You can cancel or decrease the amount of your coverage at any time.

Please contact Human Resources - Benefits to obtain a SGL application.
Premiums
Enroll or Make
Changes
LifeSuite Benefits: The State of Wisconsin offers employees with State Group Life Insurance coverage
and their eligible immediate family members the following LifeSuite services. There is no need to enroll
for these services; you are automatically eligible for them through your State Group Life Insurance
coverage.

Benefits



Beneficiaries
Travel Assistance: 24-hour emergency travel assistance services for active employees and their
eligible dependents when traveling 100 miles or more from home. For more information please
see the Travel Assistance Brochure.
Legal Services: Provides legal services to employees and eligible dependents for consultation on
simple wills, estate planning documents, and other legal issues. For more information, please see
the Legal Services Brochure.
Beneficiary Financial Counseling: Receive objective and independent financial counseling at no
cost to the employee or beneficiary. For more information, please see the Beneficiary Financial
Counseling Brochure.
Legacy Planning Services: Provides online information designed to help individuals and families
work through end-of-life issues. The site offers information about documenting instructions,
making sure legal instruments are properly drafted, and information about funeral planning. For
more information, please see the Legacy Planning Services Brochure.
Please remember to keep your beneficiaries up to date. If you need to update your beneficiaries on
file, please complete a Beneficiary Designation Form and send it directly to ETF. Unless otherwise
specified on the actual form, a Beneficiary Designation Form submitted to ETF will apply to all accounts
administered by ETF including the Wisconsin Retirement System and State Group Life Insurance.
ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D)
Open Enrollment
2015 Plan
Changes
Plan Materials
Premiums
Enroll or Make
Changes
Benefits
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You may enroll or make changes to your AD&D plan at any time.
There are no plan changes for 2015.
Please review the AD&D Brochure and the Travel Assist Brochure for more information.
Please review the AD&D Application for plan premiums.
To enroll or change your election, complete the AD&D Application and submit it to Human Resources Benefits.
Unique benefits include Exposure and Disappearance, Coma, Carjacking, Hearing Aid and Prosthetic
Appliance, Home Alteration and Vehicle Modification, Safety Device, and Therapeutic Counseling
benefits.
Enrollment includes the Zurich Travel Assist program for personal, medical, and legal assistance when
traveling abroad. Information can be found in the Travel Assist Brochure.
UW EMPLOYEES INC. LIFE INSURANCE
No Open
Enrollment
2015 Plan
Changes
Plan Materials
There is no open enrollment for UW Employees, Inc. life insurance.
The UW Employees Inc. Board of Directors approved an increase to coverage effective October 1,
2014. All program coverage levels are being increased by $3,000 with no additional cost to premiums.
For more information, please review the UW Employees, Inc. brochure.

Premiums
Make Changes
Beneficiaries

There will be no changes to premiums for 2015. Please refer to the UW Employees, Inc. brochure
for plan premiums.
The monthly premium amount is based on your age as of January 1, 2015. If an increase in your
age places you in a new premium level, you will receive a monthly premium increase on the check
you receive on December 23rd, 2014.
You can cancel your coverage at any time by contacting Human Resources-Benefits.
If you need to review or update your beneficiaries, please go to Minnesota Life’s secure website
LifeBenefits. For questions or if you have problems accessing the LifeBenefits website, please call 1877-494-1754.
SUPPLEMENTAL LIFE INSURANCE
No Open
Enrollment
2015 Plan
Changes
Plan Materials
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There is no open enrollment for Supplemental Life insurance.
There are no plan changes for 2015.
For more information, please review the Supplemental Life Insurance Brochure.
Follow this link to review the Supplemental Life Premium rates.
Premiums
The monthly premium amount is based on your coverage amount and your age as of January 1, 2015.
If an increase in your age or coverage amount places you in a new premium level, you will receive a
monthly premium increase on the check you receive on December 23rd, 2014.

Enroll or Make
Changes



Annual Option to
Increase
Coverage
Beneficiaries


You may apply for Supplemental Life Insurance at any time throughout the year (your application
will be subject to medical underwriting) by submitting an evidence of insurability application
directly to Minnesota Life.
You can cancel or decrease the amount of your coverage at any time.
Please contact Human Resources - Benefits to obtain a Supplemental Life Insurance application.
If enrolled in Supplemental Life as of January 1st, 2014, you will have an opportunity to increase
the amount of life insurance you have on you, your spouse/domestic partner, and/or your
children.
Forms to increase your life insurance will be emailed to participants the week of October 1, 2014.
The Annual Option to Increase period will be October 6 – 31, 2014 for a coverage effective date of
January 1, 2015.
If you need to review or update your beneficiaries, please go to Minnesota Life’s secure website
LifeBenefits. For questions or if you have problems accessing the LifeBenefits website, please call 1877-494-1754.
INCOME CONTINUATION INSURANCE (ICI)
No Open
Enrollment
Plan Materials
Premiums
There is no open enrollment for Income Continuation Insurance.
More information about this benefit can be found in the ICI Brochure available on ETF’s website.
Annual Premium Update: The Department of Employee Trust Funds (ETF), which administers the ICI
program, announced an overall ICI premium increase of 7.0% to go into effect on February 1st, 2015.
The new 2015 premiums can be found at the following links: Standard ICI Premiums and Supplemental
ICI Premiums.
 If you are currently enrolled in this benefit, your premium will be evaluated each year in January
based on your earnings and sick leave balance/usage from the previous year.
 The premium update that takes place in February 2015 will evaluate sick leave usage from
12/29/2013–12/27/2014.
 You will receive information from Human Resources - Benefits in mid-January 2015 regarding any
changes to your benefit or premium amount that will take effect in February 2015.

Enroll or Make
Changes

You may apply for ICI at any time throughout the year (your application will be subject to medical
underwriting) by submitting an evidence of insurability application directly to ETF.
You can cancel your coverage at any time.

Please contact Human Resources - Benefits to obtain an ICI application.
TAX SHELTERED ANNUITY (TSA/403B)
Open Enrollment
2015 Plan
Changes
Plan Materials
Contribution
Limits
Enroll or Make
Changes
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You may enroll in or make changes to this plan at any time.
The 2015 annual contribution limits will be established and announced by the IRS later this fall.
Please review the Supplemental Retirement Plans document for vendor information. For additional
information, please read the TSA page.
In 2014, you can defer a maximum of $17,500 with an additional $5,500 allowed if you will be age 50
by the end of the calendar year.
To Enroll:
 Select and contact a vendor(s) to request a TSA start-up kit. Be sure to identify yourself as a UW
Hospital and Clinics employee and provide the appropriate vendor account number.
 Employees may not enroll via the vendor’s website. A paper application is required.
 Submit the vendor application(s) and beneficiary designation directly to the vendor.
 After you receive confirmation that your account has been established, submit a Salary Reduction
Agreement (SRA) to Human Resources - Benefits.
To Make Changes: You can make changes to your contribution amount at any time by submitting a
Salary Reduction Agreement (SRA) to Human Resources - Benefits.
WISCONSIN DEFERRED COMPENSATION (WDC/457)
Open Enrollment
2015 Plan
Changes
Plan Materials
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You may enroll or make changes to this plan at any time.
The 2015 annual contribution limits will be established and announced by the IRS later this fall.
Please review the WDC Program Highlights and the WDC Roth Option Flyer for detailed information.
Please visit the WDC page for additional information.
Contribution
Limits
Enroll or Make
Changes
In 2014, you can defer a maximum of $17,500 with an additional $5,500 allowed if you will be age 50
by the end of the calendar year.
To enroll or change your WDC contribution, contact WDC at 608-241-6604 or online at
www.wdc457.org.
A representative from WDC will be available at the Employee Benefit Drop-In Sessions below to answer
any questions you may have, educate you on the program, and assist you with making changes to or
enrolling in the plan.
WDC Drop-In
Sessions
Date
10/9/2014
10/10/2014
10/23/2014
10/27/2014
Time
9:00-2:00 p.m.
10:30-1:30 p.m.
1:00-6:00 p.m.
9:00-2:00 p.m.
Building
CSC
West Clinic
CSC
CSC
Room
G5/152
1287-1288
G5/152
G5/152
DISCLAIMER: Every effort has been made to ensure that this information is correct and current. However, the terms and conditions of UWHC’s benefit
programs are established by state and federal laws and regulations and the relevant contracts. These sources of authority have control over the
information to the extent there are any differences or conflicts.