Number Title Description Audience
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-2164 Group Life Insurance Plan Monthly Rates

Monthly rates for the Wisconsin Public Employers Group Life Insurance Plan.

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

Enroll in health insurance or change your coverage.

 Active Employee, Local Employer, State Employer
ET-2304 Life Insurance Application/Cancellation/Refusal

Enroll in, cancel or decline group life insurance coverage.

 Active Employee, Local Employer, State Employer
ET-2305 Evidence of Insurability

Employees who did not enroll for group life insurance coverage during their initial enrollment period, or insured employees who wish to apply for more insurance for themselves or their spouse or dependents, may apply using this form.

 Active Employee, Local Employer, State Employer
ET-2306 Conversion Information - Life Insurance

If any portion of your group life insurance coverage terminates, you may be able to continue your life insurance protection. Your right to do this is called a conversion privilege, and its features are described here.

 Active Employee, Local Employer, State Employer
ET-2307 Income Continuation Insurance Application - State

Complete and then submit to your employer to apply for income continuation insurance.

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