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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)
s. 40.65 Duty Disability and Survivor Benefits (ET-5103)
Addendum - Traditional HMO - Standard PPP Program Option 3 (ET-2157)
Addendum - Deductible HMO - Deductible Standard Plan Program Option 4 (ET-2158)
Addendum - Deductible HMO - Deductible Standard PPP Program Option 5 (ET-2159)
Group Health Insurance (ET-4112)
Group Health Insurance Application/Change Form (ET-2301)
It's Your Choice 2012 - State Employees, Annuitants and Continuants and Graduate Assistants - Decision Guide (ET-2107d-12)
It's Your Choice 2011 - State Employees, Annuitants and Continuants and Graduate Assistants - Decision Guide (ET-2107d-11)
It's Your Choice 2010 - State Employees, Annuitants and Continuants and Graduate Assistants - Decision Guide (ET-2107d-10)
It's Your Choice 2012 - State Employees, Annuitants and Continuants and Graduate Assistants - Reference Book (ET-2107r-12)
It's Your Choice 2011 - State Employees, Annuitants and Continuants and Graduate Assistants - Reference Book (ET-2107r-11)
It's Your Choice 2010 - State Employees, Annuitants and Continuants and Graduate Assistants - Reference Book (ET-2107r-10)
It's Your Choice 2012 - Wisconsin Public Employees (Local Government Employees and Annuitants) - Decision Guide (ET-2128d-12)
It's Your Choice 2011 - Wisconsin Public Employees (Local Government Employees and Annuitants) - Decision Guide (ET-2128d-11)
It's Your Choice 2010 - Wisconsin Public Employees (Local Government Employees and Annuitants) - Decision Guide (ET-2128d-10)
It's Your Choice 2012 - Wisconsin Public Employees (Local Government Employees and Annuitants) - Reference Book (ET-2128r-12)
It's Your Choice 2011 - Wisconsin Public Employees (Local Government Employees and Annuitants) - Reference Book (ET-2128r-11)
It's Your Choice 2010 - Wisconsin Public Employees (Local Government Employees and Annuitants) - Reference Book (ET-2128r-10)
Local Annuitant Health Progam - 2011 (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)
Standard Plan - State Employees (ET-2112)
State Medicare Plus (ET-4113)
WPE Standard Plan Booklet (ET-2131)
WPE Standard PPP Plan Booklet (ET-2160)
WPE Deductible Standard Plan Booklet (ET-2161)
WPE Deductible Standard PPP Plan Booklet (ET-2162)
WPE SMP Plan Booklet (ET-2165)
WPE Deductible SMP Plan Booklet (ET-2163)
Income Continuation Insurance - Local (ET-2129)
Income Continuation Insurance - State (ET-2106)
Income Continuation Insurance Application-State (ET-2307)
Income Continuation Insurance Application-Local (ET-2366)
Income Continuation Insurance Forms/Booklets Order Form
ICI Plan Language - State and Local Government
ICI Premium Table - State (2012)
ICI Premium Rates - Local Government (2011) There will be a premium holiday in 2012 for local ICI participants.
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)
Continuation Application (ET-2154)
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
Beneficiary Financial Counseling Will Preparation and Legal Services Travel Assistance
Beneficiary Financial Counseling
Will Preparation and Legal Services
Travel Assistance
Living Benefits Brochure (ET-2327)
Notice of Death for Spouse or Dependent Child (ET-6303)
Wisconsin Public Employers Group Life Insurance Plan (ET-2101)
ETF Insurance Complaint Form (ET-2405)
Ombudsperson Services Fact Sheet (ET-8934)
Ombudsperson Program Brochure (ET-8935)
