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Benefit Options for
UW Employees with Domestic Partners

<< Annual Benefit Enrollment Opportunities

New Domestic Partner Benefit Provisions

Effective January 1, 2010, provisions within state budget bill 2009 Wisconsin Act 28 permit same sex and opposite sex domestic partners to be treated similarly to spouses for the Wisconsin Statute § Chapter 40 benefit programs administered by Employee Trust Funds (ETF).

Chapter 40 benefit programs include the State Group Health Insurance Program, the Wisconsin Retirement System (WRS), the Wisconsin Deferred Compensation Program (WDC), State Group Life Insurance and other related programs. The new provisions are effective on January 1, 2010, which is the first possible effective date of a domestic partnership for Chapter 40 benefit purposes.

Domestic partners must meet all of the following conditions:

Notes:

2009 only: Domestic Partner Requirements

If you are a new employee/appointee or otherwise eligible to enroll for benefit plans prior to January 1, 2009, and you wish to apply for domestic partner coverage, please complete the UW System Affidavit of Domestic Partnership, UWS 50 (DO NOT USE THIS FORM TO APPLY FOR 2010 DOMESTIC PARTNER BENEFITS. See the '2010 and Beyond : Domestic Partner Requirements' section below). The 2009 domestic partner benefits apply only to the following programs:

2010 and Beyond : Domestic Partner Requirements

If you are currently insured in benefit programs as of October 1, 2009, please visit the 'UW Employee Annual Benefit Enrollment Opportunities' page for specific enrollment instructions for coverage effective January 1, 2010:
http://benefits.wisc.edu/2010

For January 1, 2010 Enrollment: Please complete the following steps to establish a domestic partnership for Chapter 40 benefit purposes:

1. Review Domestic Partner Benefits, ET-2370, a detailed question and answer document regarding domestic partnership benefits.

2. Review the Imputed Income and Health Insurance Benefits page.

3. Complete the Affidavit of Domestic Partnership form to establish a domestic partnership for State of Wisconsin (Chapter 40) benefit purposes. To have your Domestic Partnership effective January 1, 2010, your Affidavit must be submitted and accepted by Employee Trust Funds (ETF) on or before December 30, 2009.

Affidavit for Domestic Partnership, ET-2371 | Submit to ETF
Affidavit for Domestic Partnership, ET-2371
Complete this affidavit with date, signatures and notarization:
a. Send the original notarized affidavit to ETF at the address on the top of the form. You may submit the notarized affidavit to ETF by fax at (608) 267-4549. The facsimile must be complete and legible; ETF may request the original document if necessary.
b. Retain copies of the notarized affidavit for submission with insurance applications and for your records.
c. ETF will send you an acknowledgement letter indicating that your Affidavit for Domestic Partnership has been accepted.
d. Attach a copy of the affidavit and your acknowledgement letter to your new insurance applications.

Deadline 1: Affidavit of Domestic Partnership; submit to ETF for acceptance by December 30, 2009 for a January 1, 2010 effective date.

Deadline 2: See the following insurance application instruction pages for deadline details:

State Group Health Insurance
Dental and Excess Medical (EPIC)
Anthem DentalBlue Insurance
VSP Vision Care Insurance
State Group Life Insurance

Imputed Income and Health Insurance Benefits

Please review the Imputed Income and Health Insurance Benefits page. Some of the essential resources, the 2010 Monthly Imputed Income Tables and the Imputed Income Calculator, are provided below.

2010 Monthly Imputed Income Tables

Table 1 : Monthly Imputed Income for State Active, Plan Year 2010
Table 2 : Monthly Imputed Income for Graduate Assistants, Plan Year 2010

Imputed Income Tables: The Fair Market Value (FMV) of insurance coverage provided for an individual who does not qualify as a dependent under Internal Revenue Code Section 152, (e.g., domestic partners and certain dependents to age 27) is taxable for employees. Therefore, the FMV of the health insurance benefit must be added to an employee’s earnings as imputed income.

The monthly imputed income amounts vary by health plan and are provided for either 1 non-tax dependent, or 2 or more non-tax dependents. These dollar amounts will be adjusted annually. Employees who are unsure if a person can be claimed as a dependent should consult IRS Publication 501 or a tax advisor.

Imputed Income Calculator

The imputed income calculator will assist you with estimating the tax implications of extending health insurance coverage to a domestic partner or eligible dependents. Use the Earnings Statement Legend to locate the values that you need for the imputed income calculation. UW-Madison employees can access their earnings statements at My UW, under the Work Record tab.


Domestic Partner Benefit Plan Options, 2009 and 2010

State Group Health Insurance

In 2009: Coverage is not available for a domestic partner.
In 2010: Effective January 1, 2010, coverage will be available for a domestic partner and his/her eligible children.  A domestic partner is treated like a spouse for purposes of the benefit programs administered by Employee Trust Funds (ETF). Please review the State Group Health Insurance instruction page.

Dental and Excess Medical Insurance (EPIC)

In 2009: Coverage is not available for a domestic partner.  An employee may name a domestic partner as a beneficiary of the Accidental Death & Dismemberment policy.
In 2010: Effective January 1, 2010, coverage will be available for a domestic partner and his/her eligible children.  Please review the Dental and Excess Medical instruction page.

Anthem Dental Insurance

In 2009: If you are a new employee/appointee or otherwise eligible to enroll for benefit plans prior to January 1, 2009, and you wish to apply for domestic partner coverage, please complete the UW System Affidavit of Domestic Partnership, UWS 50 (DO NOT USE THIS FORM TO APPLY FOR 2010 DOMESTIC PARTNER BENEFITS. See the 2010 instructions that follow.). Submit the Group DentalBlue Application with your affidavit to your benefits coordinator or your campus benefits office. Retain a copy of the documents for your records.
In 2010: Coverage is available for a domestic partner and his/her eligible children. Please review the Anthem Dental Insurance instruction page.

Vision Insurance

In 2009: If you are a new employee/appointee or otherwise eligible to enroll for benefit plans prior to January 1, 2009, and you wish to apply for domestic partner coverage, please complete the UW System Affidavit of Domestic Partnership, UWS 50 (DO NOT USE THIS FORM TO APPLY FOR 2010 DOMESTIC PARTNER BENEFITS. See the 2010 instructions that follow.). Submit the OptumHealth Vision, Vision Plan Application for UWS, EF4t with your affidavit to your benefits coordinator or your campus benefits office. NOTE: The OptumHealth Vision plan will end December 31, 2009. Retain a copy of the documents for your records.
In 2010: Coverage is available for a domestic partner and his/her eligible children. Please review the VSP Vision Care page.

Income Continuation Insurance (ICI)

This plan covers employees only.
No coverage is available for a spouse or domestic partner.

State Group Life Insurance

In 2009: Coverage is not available for a domestic partner.
In 2010: Effective January 1, 2010, a domestic partner is treated like a spouse for purposes of the benefit programs administered by Employee Trust Funds (ETF). Please review the State Group Life Insurance instruction page.

Individual & Family Group Life Insurance

In 2009: If you are a new employee/appointee or otherwise eligible to enroll for benefit plans prior to January 1, 2009, and you wish to apply for domestic partner coverage, please complete the UW System Affidavit of Domestic Partnership, UWS 50 (DO NOT USE THIS FORM TO APPLY FOR 2010 DOMESTIC PARTNER BENEFITS. See the 2010 instructions that follow.). Submit the Application / Cancellation / Change Request, 03-30539 with your affidavit to your benefits coordinator or your campus benefits office. Retain a copy of the documents for your records.
In 2010: Enrollment instructions to be determined.

University Insurance Association Life Insurance (UIA)

This plan covers employees only.  No coverage is available for a spouse or domestic partner.

UW Employees, Inc. Life Insurance

This plan covers employees only.  No coverage is available for a spouse or domestic partner.

Accidental Death & Dismemberment Insurance (AD&D)

In 2009: The family policy is available for a domestic partner and his/her eligible children. For 2009 coverage only, please complete the UW System Affidavit of Domestic Partnership, UWS 50 (DO NOT USE THIS FORM TO APPLY FOR 2010 DOMESTIC PARTNER BENEFITS. See the 2010 instructions that follow.).
In 2010: Enrollment instructions to be determined.

Employee Reimbursement Accounts (ERA)

Please review the ERA - Plan Year 2010 Enrollment page and the questions and answers below:

ERA Questions : Domestic Partner -  | Source: ETF ERA FAQ
Q: Can I use the Employee Reimbursement Account program to pay the qualifying medical expenses of my domestic partner, his/her dependents or my adult child?

A: No, federal tax regulations do not allow the use of flexible benefit plans to pay for medical expenses on a pre-tax basis unless the domestic partner, partner’s child, or your adult child qualifies under the Internal Revenue Code as a tax dependent at the time the expense was incurred.

Q: How can I determine if my domestic partner or adult child qualifies under the Internal Revenue Code as my tax dependent? Consult the guidelines in IRS Publication 501 for “qualifying relative.” In general, the IRS requires that a qualifying relative meet four tests:
- The dependent does not meet the “qualifying child” tests;
- The dependent must live with you all year as a member of your household;
- The dependent’s gross income must be less than $3,500 for the year;
- You must provide more than half of the dependent’s support for the year.

The lists above should not be used as the sole determination of your dependent’s tax status. These tests are described in detail in IRS Publication 501, which is available at the Internet Web site of the Internal Revenue Service.

Q: Can I use the Employee Reimbursement Account program to pay for the dependent care of my domestic partner’s dependent child?

A: No, federal tax regulations do not allow the use of flexible benefit plans to pay for dependent care of a domestic partner’s child on a pre-tax basis unless the child qualifies under the Internal Revenue Code as the employee’s tax dependent at the time the care expense was incurred.

Wisconsin Retirement System (WRS)

In 2009: Effective January 1, 2000, the WRS death benefit that is payable if an employee dies while in active service is the same regardless of the beneficiary's relationship to the employee. At retirement an employee can name anyone as a beneficiary of a Life Annuity or as a Joint Survivor.
In 2010: Effective January 1, 2010, a domestic partner is treated like a spouse for purposes of the benefit programs administered by Employee Trust Funds (ETF). Review Domestic Partner Benefits, ET-2370, a detailed question and answer document regarding domestic partnership benefits.

Long Term Care Insurance | ETF Page

United of Omaha Assured Solutions Plus (through Health Choice)
Domestic partners are eligible for a 10% two person household discount when both persons apply for and are issued coverage. A two person household is defined as two adults (age 18 or older), living together on a continuous basis for at least 12 months.

John Hancock Custom Care II (through Senior Care)
If employee and partner have lived together for at least five years and one member of the household carries coverage, he/she is eligible for a 15% discount. If both people in the household are approved for coverage, each person will receive a 30% discount. Partners include policyholders who: are married; have lived with a family member of the same generation (sibling or cousin) for at least five years; or have lived with a same-sex or different-sex partner for at least five years.

Sick Leave

Regarding the use of sick leave to provide care for a spouse or domestic partner during illness, as of 2009:

Employees who are eligible to use sick leave to care for a domestic partner during illness include:

Employees not eligible to use sick leave to care for a domestic partner during illness include:

Family and Medical Leave Act (FMLA)

Employees cannot use federal FMLA leave to care for a domestic partner with a serious health condition.

Wisconsin Family and Medical Leave Act (WFMLA)

Effective June 30, 2009 domestic partners are included under the Wisconsin Family and Medical Leave Act (WFMLA).  Employees may request WFMLA leave to care for a seriously ill domestic partner or the domestic partner’s parents.  The provision does not extend to a domestic partner’s children unless the children are legally adopted by the employee.

 

Further Information on 2009 Domestic Partner Requirements

To extend insurance coverage to a same or opposite sex domestic partner, the employee and domestic partner must be in an established domestic partnership of at least six months and meet the criteria described in the Affidavit of Domestic Partnership, UWS-50.

Affidavit of Domestic Partnership, UWS-50 (for 2009 only)
The Affidavit of Domestic Partnership, UWS-50 is required for enrollment in any domestic partner insurance and the Employee Reimbursement Account (ERA) program.  The Affidavit of Domestic Partnership, UWS-50 is not the same as the UW-Madison Declaration of Domestic Partnership Form, although it may be used by UW-Madison to establish other domestic partnership benefits.

If a domestic partnership terminates, the Affidavit of Termination of Domestic Partnership, UWS-51 form must be completed and submitted to your Payroll and Benefits Coordinator along with the applicable insurance and/or ERA form(s).  There must be at least a six-month period after a partnership termination, before a new Affidavit of Domestic Partnership, UWS-50 can be submitted.