ET-4305
Form Active Employee / Retiree

Sick Leave Escrow Application

Apply to escrow your sick leave credits, if eligible. To escrow means to preserve or bank your sick leave credits for use at a later date.

ET-4317
Form Active Employee / Retiree

Sick Leave Re-enrollment Application

Re-enroll for group health insurance coverage during the annual It’s Your Choice open enrollment period or after an involuntary loss of your comparable non-state coverage, if eligible.

ET-2144
Flyer Active Employee / Retiree / Other Benefit Recipient

State of Wisconsin Health Benefit Program Data Flow

Learn how the data warehouse securely collects and stores enrollment, claims, and wellness data for all participants of the Group Health Insurance Program.

ET-4427
Form Active Employee / Retiree / Other Benefit Recipient

Statement of Incapacity for Finances and Property

Form for the member’s physician to complete if the member cannot manage property, finances or business affairs because of an impairment in the ability to receive and evaluate information or make or communicate decisions even with the use of technological assistance.