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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2017 Local Deductible Health Plan Insurance Program
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2017 It's Your Choice - Local Deductible Health Plan Insurance for Employees and Retirees
Wisconsin Department Of Employee Trust Funds It's Your Choice 2017

Local Deductible Plan
Insurance for Employees
and Retirees
(PO4, PO14)

Decline Uniform Dental Benefits

In 2016, you were able to choose your health insurance, with or without Uniform Dental Benefits, if your employer offered the Uniform Dental Benefit.

If you do not make any changes for 2017, you will continue with the same coverage you elected for 2016, if your employer offers the Uniform Dental Benefit. For example, if you chose to decline Uniform Dental Benefit coverage for 2016, you will not have the Uniform Dental Benefit for 2017 unless you file a Group Health Insurance Application/Change (ET-2301) form. You can make a change in myETF Benefits, or complete a paper application and submit it to your benefits office if you are an employee, or to ETF if you are a retiree. See more on how to add or decline the Uniform Dental Benefit on the paper for or myETF Benefits.

You will have an opportunity to add or decline your Uniform Dental Benefit coverage during It’s Your Choice open enrollment. New employees will choose health insurance with or without Uniform Dental Benefits during the application process. Check your contribution rates for the cost difference between medical benefits with and without Uniform Dental Benefits.



Enroll or Make Changes:
myETF Benefits provides employees the ability to submit changes to their current coverage including address/name changes, new enrollments, and qualifying event changes to their existing coverage online.



Every effort has been made to ensure that this information is accurate, but may be subject to change. Please note revision dates located at the bottom of each page. In the event of conflicting information, federal law, state statute, state health contracts and/or policies and provisions established by the State of Wisconsin Group Insurance Board shall be followed.

This page was last modified on: 10/3/2016 2:41:09 PM