Wisconsin Retirement System pension, health insurance and other benefits can be complex and confusing. It’s your responsibility to read, understand and ask questions. Remember: The Department of Employee Trust Funds is also here to help.
Our best advice is to learn as much as possible about your benefits and always be a strong advocate for you and your family. Take time for the following:
· Review ETF forms and publications
· Watch an ETF video
· Use the Benefits Available to Me page or other ETF website resources
· Contact ETF and speak with a benefits specialist, who can assist you with most benefits-related matters.
If your issue is related to a health, pharmacy or dental benefit claim or billing, first call either your health plan, or Navitus (pharmacy benefits), or Delta Dental (dental benefits).
When additional assistance is needed, you can rely on Ombudsperson Services. For 28 years this unit, housed within ETF’s Office of Legal Services, has been helping members resolve benefits disputes while providing overall education, guidance, and support.
An ombudsperson acts as an impartial and neutral party for equity, fairness and compliance with WRS benefits program policies and insurance contracts. Get help with:
· A prior authorization request for services that has been denied
· Transition to Medicare or how your health insurance plan coordinates with Medicare
· Clarification on covered services
· Filing a grievance or requesting an external review of a denied claim
· Claims that were not processed correctly
· And more