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Publications

Insurance Forms and Publications

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Authorization

Authorization to Disclose Medical Information (ET-7414)  

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

Disability Insurance

Disability Retirement Benefits (ET-5107)

Income Tax Withholding Election (ET-4310)

Long-Term Disability Insurance (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

2017 Group Health Insurance Guides

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

It's Your Choice 2017 Decision Guide for State Employees (17et2107)

It's Your Choice 2017 Decision Guide for State Retirees (17et2108)

State IYC Access Plan (ET-2112)

IYC Medicare Plus (ET-4113)

IYC Access Plan HDHP (ET-2170)

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

It's Your Choice 2017 Local Traditional Plan Decision Guide (17et2128)

It's Your Choice 2017 Local Deductible Plan Decision Guide (17et2158)

It's Your Choice 2017 Local Health Plan Decision Guide (17et2168)

It's Your Choice 2017 Local High Deductible Health Plan Decision Guide (17et2169)

WPE Traditional IYC Access Health Plan (ET-2131)

WPE Coinsurance IYC Access Health Plan (ET-2160)

WPE Deductible IYC Access Health Plan (ET-2162)

IYC Access Plan HDHP (ET-2170)

Medicare Plus Booklet (ET-4113)

2016 Group Health Insurance Guides

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

It's Your Choice 2016 Decision Guide for State Employees (16et2107)

It's Your Choice 2016 Decision Guide for State Retirees (16et2108)

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

It's Your Choice 2016 Local Traditional Plan Decision Guide (16et2128)

It's Your Choice 2016 Local Deductible Plan Decision Guide (16et2158)

It's Your Choice 2016 Local Health Plan Decision Guide (16et2168)

It's Your Choice 2016 Local High Deductible Health Plan Decision Guide (16et2169)

Other Health Insurance Publications

Group Health Insurance (ET-4112)

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

Local Annuitant Health Program (ET-2156)

Local Annuitant Health Program Fact Sheet (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

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)

ICI Plan Language - State and Local Government 

Life Insurance

Beneficiary Designation (ET-2320)

Beneficiary Designation - Alternate (ET-2321)

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 (ET-2164)

Group Life Insurance Local Overview

Group Life Insurance State Overview

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

Life Suite - Summary

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)

Optional Insurance Plans

Guidelines for Optional Insurance Plans (ET-7422)

Standards for Proposing and Providing Long-term Care Insurance (ET-7423)

 

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