During Open Enrollment

Changes in coverage become effective January 1, 2021.

Health Insurance & Uniform Dental

Complete a Health Insurance Application/Change For Retirees & COBRA Continuants (ET-2331) form or log in to myETF.wi.gov.

  • myETF.wi.gov is available for currently enrolled retirees only.
  • If your family has some members with Medicare and some without Medicare, you will need to complete and submit a paper Health Insurance Application/Change For Retiress & COBRA Continuants (ET-2331) form to change coverage.

Contact ETF with questions.

Supplemental Benefits

Dental

You have two ways to enroll in the Preventive, Select or Select Plus Plans:

  1. Complete the State of Wisconsin- ETF Supplemental Dental Open Enrollment Form and mail the completed form to Delta Dental at the address on the bottom of the form.
  2. Enroll online.
Vision

You have two ways to enroll:

  1. Enroll online at the DeltaVision website.
  2. Complete and return the supplemental vision enrollment form for retirees/continuants.

Contact DeltaVision with enrollment questions at 1-844-337-8383.

Health Savings Account

For High Deductible Health Plan (HDHP) enrolled participants only:


When you Experience a Life Change Event

You can enroll or make changes to your benefits if you have had a qualifying life event.

For changes to:

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