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Publications

Insurance Forms and Brochures

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Authorization Forms

Authorization to Disclose Medical Information (ET-7414)  

Request to Copy or Inspect Medical Information (ET-2421)

Disability Insurance Forms

Disability Benefits Folder (ET-5107)

Income Tax Withholding Election (ET-4310)

Long-Term Disability Insurance Folder (ET-5108)

Long-Term Disability Insurance Benefit Claim Form and Instructions (ET-5313)

s. 40.65 Duty Disability and Survivor Benefits (ET-5103)

Health Insurance Forms

2014 Group Health Insurance Guides

State of Wisconsin Group Health Insurance Program
(State government employees, annuitants, continuants and UW graduate assistants)

It's Your Choice 2014 Decision Guide (ET-2107d-14)

It's Your Choice 2014 Reference Guide (ET-2107r-14)

State Standard Plan (ET-2112)

State Medicare Plus (ET-4113)

Wisconsin Public Employers Group Health Insurance Program
(Local government employees and annuitants)

It's Your Choice 2014 Decision Guide (ET-2128d-14)

It's Your Choice 2014 Reference Guide (ET-2128r-14)

WPE Standard PPO Plan Program Option 2 Booklet (ET-2131)

WPE Standard PPO Plan Program Option 6 Booklet (ET-2160)

WPE Standard PPO Plan Program Option 4 Booklet (ET-2162)

Medicare Plus Booklet (ET-4113)

Addendums

Deductible HMO-Standard PPO Program Option 4 (ET-2158)

Coinsurance HMO-Standard PPO Program Option 6 (ET-2168)

2013 Group Health Insurance Guides

Use the myETF Benefits online tool to make It's Your Choice changes.

Group Health Insurance Application/Change Form (ET-2301)

How to Complete the ET-2301 Presentation

State of Wisconsin Group Health Insurance Program
(State government employees, annuitants, continuants and UW graduate assistants)

It's Your Choice 2013 - Decision Guide (ET-2107d-13)

It's Your Choice 2013 - Reference Guide (ET-2107r-13)

State Standard PPO Booklet (ET-2112)

Medicare Plus Booklet (ET-4113)

Wisconsin Public Employers Group Health Insurance Program
(Local government employees and annuitants)

It's Your Choice 2013 - Decision Guide (ET-2128d-13)

It's Your Choice 2013 - Reference Guide (ET-2128r-13)

WPE Standard PPO Plan Program Option 2 Booklet (ET-2131)

WPE Standard PPO Plan Program Option 6 Booklet (ET-2160)

WPE Standard PPO Plan Program Option 4 Booklet (ET-2162)

Medicare Plus Booklet (ET-4113)

Addendums

Deductible HMO - Deductible Standard PPO Program Option 4 (ET-2158)

Coinsurance HMO - Standard PPO Program Option 6 (ET-2168)

Other Health Insurance Publications

Group Health Insurance (ET-4112)

Group Health Insurance Application/Change Form (ET-2301)
How to Complete the ET-2301 Video

Local Annuitant Health Program Booklet (ET-2156)

Local Annuitant Health Program Fact Sheet- 2012 (ET-9019)

Medicare Eligibility Statement (ET-4307)

Sick Leave Conversion Credit Brochure (ET-4132)

Sick Leave Escrow Application (ET-4305)

Sick Leave Re-enrollment Application (ET-4317)

Income Continuation Insurance Forms

Income Continuation Insurance - Local (ET-2129)
There will be a premium holiday in 2012 for local ICI participants.

Income Continuation Insurance - State (ET-2106)

Income Continuation Insurance Application-State (ET-2307)

Income Continuation Insurance Application-Local (ET-2366)

ICI Plan Language - State and Local Government 

Life Insurance

Beneficiary Designation (ET-2320)

Conversion Information - Life Insurance (ET-2306)

Converting Your Group Life Insurance to Pay Health or Long-Term Care Insurance Premiums (ET-2325)

Evidence of Insurability (ET-2305)

Group Life Insurance After You Terminate Employment (ET-4104)

Group Life Insurance Plan Monthly Rates-2010-2011 (ET-2164)

Life Insurance Application/Cancellation/Refusal (ET-2304)

Life Suite - Summary

Beneficiary Financial Counseling

Will Preparation and Legal Services

Travel Assistance

Legacy Planning Services

Living Benefits Brochure (ET-2327)

Notice of Death for Spouse or Dependent Child (ET-6303)

Wisconsin Public Employers Group Life Insurance Plan (ET-2101)

Ombudsperson Services

ETF Insurance Complaint Form (ET-2405)

Ombudsperson Services Fact Sheet (ET-8934)

Ombudsperson Program Brochure (ET-8935)

 

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