Monthly Premiums and Coverage Levels
| Coverage Level | Single Coverage Monthly Premium |
Family Coverage Monthly Premium |
|---|---|---|
| $25,000 | $0.65 | $1.00 |
| $50,000 | $1.30 | $2.00 |
| $100,000 | $2.60 | $4.00 |
| $150,000 | $3.90 | $6.00 |
| $200,000 | $5.20 | $8.00 |
| $250,000 | $6.50 | $10.00 |
| $300,000 | $7.80 | $12.00 |
| $350,000 | $9.10 | $14.00 |
| $400,000 | $10.40 | $16.00 |
| $450,000 | $11.70 | $18.00 |
| $500,000 | $13.00 | $20.00 |
The Employer does not contribute towards the premium.
Eligibility
You must meet the following requirements to enroll in this plan:
- Eligible for State Group Health Insurance
- Not receiving a Wisconsin Retirement System (WRS) annuity
If an employee and their spouse/domestic partner are both eligible for this plan, the employee and their spouse/domestic partner may only be covered as an employee or a dependent—not both. This rule also applies to children who are also eligible for this plan as an employee.
Enrollment
You may enroll, change or cancel your coverage at any time. If you enroll during your initial 30-day enrollment period, your coverage will begin on the first day of the month following 30 days from your date of hire. If you enroll outside your initial enrollment period, coverage will begin the first of the month on or following receipt of your application.
Coverage Levels
You may elect coverage levels that range from $25,000 to $500,000. If you enroll in Family coverage, the benefit amount of your family members coverage will be a percentage of the employee benefit amount.
Additional Benefits
- Zurich Travel Assist provides benefits when an employee travels at least 100 miles from their home. Print your Zurich Travel Card for your next trip. Policy number is GTU8364005.
- CyberScout LifeStages Identity Management Services provides identity theft education and personalized resolution resources.
- Continuation of group policy coverage at retirement.
- Conversion of coverage to an individual policy at the end of employment.
Full coverage details are available in the AD&D Plan Certificate.
You should review and update your Beneficiary Designation with each qualifying life event.
Forms
Continuation Form – contact the UW Service Center at servicecenter@uwsa.edu or by calling 888-298-0141 (7:45 am–4:40 pm Monday-Friday) if you need a continuation form.
Publications
- AD&D Fact Sheet
- Zurich Travel Assist Services
- Zurich Travel Card
- Identity Management Services Brochure
- Identity Management Wallet Card
-
Certificate of Insurance
Details of services that will and will not be covered.
- AD&D Conversion Privilege