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.
ET-4702
Brochure
Active Employee /
Retiree /
Other Benefit Recipient /
Local Employer /
State Employer
Wisconsin law requires the WRS participant to complete this form and submit it ETF when a portion of the participant’s account is awarded to an alternate payee via a Qualified Domestic Relations Order (QDRO).
Under certain circumstances, reciprocity may increase the retirement benefits payable to you if you worked for one or more participating public retirement systems.
File a copy of this form with each of your former retirement systems each time you become covered under a new retirement system, for limited reciprocity between the three public employee retirement systems in Wisconsin.