Number Title Description Audience
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-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
ET-8108 Nondiscrimination and Language Access

ETF complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.

 Active Employee, Retiree, Other Benefit Recipient, Local Employer, State Employer
ET-8900 Employee Reimbursement Accounts Fact Sheet

The Employee Reimbursement Accounts (ERA) Program is an optional benefit that allows participants to use pre-tax dollars to pay for certain Internal Revenue Service-approved expenses.

 Active Employee, Retiree, Local Employer, State Employer
ET-8902 Group Health Insurance Fact Sheet

The group health insurance program is an employer-sponsored program offering group health coverage to employees of state agencies, UW System, UW Hospital & Clinics Authority and participating local government employers.

 Active Employee, Retiree, Local Employer, State Employer
ET-8928 ETF Online Access Security Agreement

Employers, complete this form for access to ETF systems.

Local Employer, State Employer
ET-8929 Accumulated Sick Leave Conversion Credit Program & Supplemental Health Insurance Conversion Credit Program Fact Sheet

The ASLCC and SHICC programs were created by Wis. Stat. § 40.05 (4) (b). The ASLCC Program was first authorized in 1972; the SHICC program was first authorized in 1995.

 Active Employee, Retiree, Local Employer, State Employer
ET-8933 Pharmacy Benefits Program Fact Sheet

The State of Wisconsin Group Insurance Board contracts with a Pharmacy Benefit Manager to provide administrative services to State of Wisconsin and Wisconsin Public Employer group health insurance program participants.

 Active Employee, Retiree, Local Employer, State Employer