Number Title Description Audience
ET-1908 Employer Attestation For Documentation Received

Employers, use this form to verify that you viewed the employee’s original required document(s) to verify the employee or dependent(s) is eligible for benefit coverage, as administered by ETF.

 Local Employer, State Employer
ET-2154 Group Life Insurance Continuation Application

This application is intended for insured employees who are terminating Wisconsin Retirement System employment, who may qualify to continue life insurance coverage, and who will not begin a WRS retirement benefit immediately.

 Active Employee, Local Employer, State Employer
ET-2155 Group Health Insurance Program Continuation Application

For State Employees With 20 Years of WRS-Creditable Service. Employers, complete your sections and then give the form to the employee.

 State Employer
ET-2166 Domestic Partner Benefits

As of Sept. 23, 2017, the State of Wisconsin no longer allows the establishment of new domestic partnerships under Chapter 40 of the Wisconsin statutes. This brochure provides information about the benefit changes for established domestic partnerships.

 Active Employee, Retiree, Other Benefit Recipient, Board Member, Local Employer, State Employer
ET-2167 myETF Benefits Quick Start Guide

myETF Benefits provides online tools to enroll and manage your health insurance benefits.

 Active Employee, Local Employer, State Employer
ET-2301 Health Insurance Application/Change Form

Enroll in health insurance or change your coverage.

 Active Employee, Local Employer, State Employer
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