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.
You have two ways to enroll in the Preventive, Select or Select Plus Plans:
- 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.
- Enroll online.
You have two ways to enroll:
- Enroll online at the DeltaVision website.
- 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:
- Current enrollees: Submit a paper form to ETF. You must re-enroll each year. Enrollment does not carry forward from year to year. HSA information can be found online through ConnectYourCare.
- New enrollees: Submit a paper form to ETF.
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:
- Health Insurance & Uniform Dental: Submit a Health Insurance Application/Change For Retirees & COBRA Continuants (ET-2331) form.
- Vision: Complete the supplemental vision enrollment form for retirees/continuants.
- Supplemental Dental: Complete the enrollment change form found on Delta Dental’s website.