Below is a link to PBA, the third party administrator of the medical plan, in regard to downloading MRFs as required by the Consolidated Appropriations Act (CAA) & Transparency In Coverage regulation. 

https://www.pbaclaims.com/mrfs/

2026 Master Plan Document

HIPAA Privacy Policy

Medical Plan Information

• 2026 Health Plan Resource Guide for Members
• 2026 Benefits Guide for General, LPPNSA, LPPSA, IAFF (hired after 7/1/11), & Library
• 2026 Benefit Guide for ATU
• 2026 Benefit Guide for IAFF (hired before 7/1/11)
• City's Medical Plan Precertification vs. Preauthorization 2023
• How to Search for a Network Provider
• Frequently Asked Questions About the Medical Plan
• Anthem LiveHealth Online Video Doctoring
• Optometrist Directory - Anthem Network as of 7/20/2023
• Serve You Rx Member Portal
  • For a list of covered drugs:
    
    • Visit www.serve-you-rx.com
    • Select "Members" from the menu
    • Scroll down to "Check if a Drug is on My Formulary"
    • Choose "Preferred Drug List -Biosimilar Advantage"
• Prescription Drug Co-Payment & Mail Order Information
• Legal Notices for 2026

Quick One Page Summaries (see Schedule of Benefits or Master Plan for detailed information)

• 2026 ATU Local 519 Medical Plan
• 2026 General Traditional Plan (Employee Handbook, Library, LPPNSA, LPPSA, & IAFF hired after 7/1/11)
• 2026 General HDHP (Employee Handbook, Library, LPPNSA, LPPSA, & IAFF hired after 7/1/11)
• 2026 IAFF Local 127 2500 (Employees hired prior to 7/1/11)
• 2026 IAFF Local 127 HDHP (Employees hired prior to 7/1/11)

Schedule of Benefits

• 2026 ATU Local 519 Medical Plan
• 2026 General City Medical Traditional Plan (LPPNSA, LPPSA, Employee Handbook, Library, IAFF hired after 7/1/11)
• 2026 General City Medical High-Deductible Health Plan (LPPNSA, LPPSA, Employee Handbook, Library, IAFF hired after 7/1/11)
• 2026 IAFF Local 127 2500 Deductible Plan (Employees hired prior to 7/1/11)
• 2026 IAFF Local 127 High-Deductible Health Plan (Employees hired prior to 7/1/11)

Summary of Benefits and Coverage

• 2026 ATU Local 519 Medical Plan
• 2026 General City Medical Traditional Plan (LPPNSA, LPPSA, Employee Handbook, Library, IAFF hired after 7/1/11)
• 2026 General City Medical High-Deductible Health Plan (LPPNSA, LPPSA, Employee Handbook, Library, IAFF hired after 7/1/11)
• 2026 IAFF Local 127 2500 Deductible Plan (Employees hired prior to 7/1/11)
• 2026 IAFF Local 127 High-Deductible Health Plan (Employees hired prior to 7/1/11)
• Uniform Glossary of Health Coverage and Medical Terms

Quick Links

• Professional Benefits Administrator (PBA) 1-800-435-5694 or www.pbaclaims.com
• Serve You Rx (Pharmacy Benefit Administrator) 1-800-759-3203 or www.serveyourx.com
• Neighborhood Family Clinic
• Gundersen Express Care

2026 Delta Dental Insurance

• 2026 Guide to Your Dental Benefits
• 2026 How to Search Delta Dental Network
• Delta Dental Summary Plan Document HIGH Plan (complete details)
• Delta Dental Summary Plan Document LOW Plan (complete details)

• 2026 Vision Plan Summary of Benefits
• EyeMed Member Portal Information
• Vision Plan Certificate of Coverage
• Vision Plan HIPAA Notice
• Vision Plan COBRA Notice
• Contact EyeMed: www.eyemedvisioncare.com/unum or 855-652-8686

• ETF’s Home Page
• WRS “Your Benefit Handbook”
• ETF’s “Retirement Planning Checklist”
• WRS Guide to Retirement
• ETF Benefit Presentations (video, face-to face or webinars)
• Beneficiary Designation Form
• Employees represented by ATU (Transit) collective bargaining agreement
• Employees represented by IAFF (Fire) collective bargaining agreement
• Employees represented by LPPNSA & LPPSA (Police) collective bargaining agreement
• Non-Represented employees under the Employee Handbook
• Employees of the Library

• To request an enrollment kit, please contact HR at (608)789-7595 or email.
• Contact MissionSquare (formerly ICMA)

• ETF’s “Group Life Insurance Program” booklet
• Beneficiary Designation Form

• ETF’s “Income Continuation Insurance” booklet
• For assistance filing a claim, please contact Angi Leisso, Benefits Specialist, at (608) 789-8310 or leissoa@cityoflacrosse.org. 

Offered beginning 1/1/2026 through the State of Wisconsin by Securian Financial to employees enrolled in the Wisconsin Retirement System.

Home | Life Benefits

Phone: 1-866-295-8690 

ASI Flex

(800) 659-3035
Visit ASIFlex.com 

Summary Plan Description

Overview of Health FSA

Overview of Dependent Care FSA

• To request an enrollment kit, please contact HR at (608)789-7595 or email.
• Contact MissionSquare (formerly ICMA)

• General Info FMLA
• Instructions for filing FMLA

The Employee Assistance Program (EAP) benefit is available at no cost to full and part-time City employees (eligible for benefits) and their legal spouse/dependents (ages 12 and older), providing professional, confidential assistance to help individuals resolve concerns that affect their personal lives or work performance. Individuals and immediate family members can receive up to six (6) sessions per issue at no cost. EAP is available 24 hours a day, seven (7) days a week. Information shared is confidential and NOT provided to your health care provider or employer.

To learn more about the Employee Assistance Program through Gundersen Health System, please check out the below resources.

How can the Employee Assistance Program help you?

Help when you need it - meet the staff

Employee Assistance Program website