National Medical Support Notice

Program Option
  • Local Deductible Health Plan (PO14) & Supplemental Benefits
  • Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits
  • Local Health Plan (PO16) & Supplemental Benefits
  • Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits
  • Local High Deductible Health Plan (PO17) & Supplemental Benefits
  • Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits
  • Local Traditional Health Plan (PO12) & Supplemental Benefits
  • Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits
  • State Employee and Retiree Health Plan & Supplemental Benefits
Health and Wellness News
Nov 19, 2024 1:00pm
Child holding a vegetable and placing it near their parent's ear. Graphic texts: WHERE YOU BELONG: Find health and closer connection. It's Your Health: Diabetes

November is National Diabetes Month

Join us this month in learning about diabetes, prediabetes, and Well Wisconsin's diabetes management coaching program.

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Privacy and Policy Notices

We are committed to following legal policy and protecting the privacy of all members and visitors to our website. Please read our policy statements to understand how we protect the information that we collect, use, and share.

Notice of Privacy Practices

Program Option
  • Local Deductible Health Plan (PO14) & Supplemental Benefits
  • Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits
  • Local Health Plan (PO16) & Supplemental Benefits
  • Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits
  • Local High Deductible Health Plan (PO17) & Supplemental Benefits
  • Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits
  • Local Traditional Health Plan (PO12) & Supplemental Benefits
  • Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits
  • State Employee and Retiree Health Plan & Supplemental Benefits
ET-6301
Form Other Benefit Recipient

Notice of Death

Notify the third party administrator of the group life insurance program of a member death.

​​​​​​​Public Records Notices

Recognizing the people’s right to information about the government’s decision making process, the Department of Employee Trust Funds will, consistent with the state’s Public Records Law (Wis. Stat. §§ 19.31 to 19.39), provide information regarding ETF’s affairs, except for individual personal information restricted by statute.

General Privacy Notice

The Wisconsin Department of Employee Trust Funds is a state agency. ETF administers Wisconsin Retirement System and other benefits for state and local government employees. Benefits include retirement, health, and sick leave benefits; disability benefits; life insurance; income continuation insurance; and pre-tax savings accounts.

To provide you with these services, ETF maintains certain personal information about you. The purpose of this document is to help you understand what types of information we have, why we have it, and how we use and protect it.

Specialty Medication Programs

Level 4 self-injectables and specialty medications are available through specific pharmacies for non-Medicare members while members on Medicare have some additional pharmacy options.

Program Option
  • Local Annuitant Health Program (LAHP)
  • Local Deductible Health Plan (PO14) & Supplemental Benefits
  • Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits
  • Local Health Plan (PO16) & Supplemental Benefits
  • Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits
  • Local High Deductible Health Plan (PO17) & Supplemental Benefits
  • Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits
  • Local Traditional Health Plan (PO12) & Supplemental Benefits
  • Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits
  • State Employee and Retiree Health Plan & Supplemental Benefits
Some Out-Of-State Coverage

Medical Associates Health Plan

Major Health Systems
  • Medical Associates Clinic
  • Mercy Medical Center - Dubuque
  • Crossing Rivers Health
  • Grant Regional Health Center
  • Southwest Health Center
Full Service Areas
  • Crawford County
  • Grant County
  • Iowa County
  • Lafayette County
Limited Service Areas
  • Iowa
  • Illinois
ET-2311
Form Active Employee / Local Employer / State Employer

COBRA Continuation - Conversion Notice

Under federal law, known as COBRA, you and your qualified beneficiaries may continue group health insurance coverage, if eligible.