Number Title Description Audience
ET-2311 COBRA Continuation - Conversion Notice

Under federal law, known as COBRA, you and your qualified beneficiaries may continue group health insurance coverage, if eligible.

 Active Employee, Local Employer, State Employer
ET-2314 Request for Treatment as an Assistance Eligible Individual

The American Rescue Plan Act of 2021 (ARP) subsidizes the full COBRA premium for “Assistance Eligible Individuals” for periods of coverage from April 1, 2021 through September 30, 2021.

 Local Employer, State Employer
ET-2314a Model COBRA Subsidy Notice

This is the Model Notice for COBRA Continuation Subsidy under the American Rescue Plan [ARP] Act of 2021. Employers please note that information for qualified beneficiaries must be completed. 

 Local Employer, State Employer
ET-2331 Health Insurance Application/Change for Retirees

Retirees, enroll in health insurance or change your coverage.

 Retiree, Other Benefit Recipient, Local Employer, State Employer
ET-2340 Automatic Premium Conversion Waiver/Revocation of Waiver

Complete this form to waive your participation in automatic premium conversion, or to revoke a waiver of premium conversion that you filed previously.

 Active Employee, Local Employer, State Employer
ET-2384 Employee Reimbursement Accounts (ERA) Enrollment

For UWs use only, as a paper alternative for a member who cannot complete their ERA enrollment online.

 Active Employee, Local Employer, State Employer
ET-2385 Health Savings Account (HSA) Enrollment

For UWs use only, as a paper alternative for a member who cannot complete their HSA enrollment online.

 Active Employee, Local Employer, State Employer
ET-2572 New Employee Benefit Checklist

A tool for an employer to confirm information was presented to a new employee, due dates identified and appropriate information and forms supplied for all ETF-administered benefits offered by the employer.

 Local Employer, State Employer
ET-2572a New Employer Agent/Contact Wisconsin Retirement System Training Checklist

Checklist for a new employer agent or an employer’s new retirement/insurance contact with the ETF.

 Local Employer, State Employer
ET-4112 Group Health Insurance

This brochure includes general information about health insurance through ETF.

 Active Employee, Retiree, Local Employer, State Employer