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Employers

January 15, 2019

Updated Life Insurance Forms and Documents

Due to recent changes to the life insurance program, several updates have been made to multiple forms and documents associated with the program:

The Wisconsin Public Employers Group Life Insurance Program ( ET- 2101) brochure - changes include:

  • The color of the cover page changed to blue with a revision date of 12/2018.      
  • Modified language in sections 12 and 13 to match the recent change of the effective cancellation date for an employee who voluntarily elects to cancel their life insurance coverage (Employer Bulletin Vol. 35, No. 19).  
  • Removed all long-term disability insurance (LTDI) language from the brochure.
    • The LTDI program closed new claims at the end of 2017.

The Wisconsin Public Employers Group Life Insurance Plan Monthly Employee Premium Rates Per $1000 of Insurance (ET-2164) - changes include:

  • The 5% increase approved by the Group Insurance Board for the state plan (Employer Bulletin Vol. 35, State F).
    • The premium increase is effective April 1, 2019.
    • The local plan did not experience a premium increase.  

The Wisconsin Public Employers Group Life Insurance Program Administration Manual (ET-1117) - changes include:

The Life Insurance Application/Cancellation/Refusal (ET-2304) form - changes include:

  • Modified language to match the recent change of the effective cancellation date for an employee who voluntarily elects to cancel their life insurance coverage.

Paper copies may be ordered online.

 

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