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.

A lock over a data screen of 0s and 1s.

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.

ET-4303
Form Active Employee / Local Employer / State Employer

Waiver of Part-Time Elected Service

Form for elected officials to irrevocably waive further participation in the WRS for current, and any future, service as an elected official that does not exceed 1,044 hours per year.

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.

​​​​​​​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.

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

You or Your Dependent Has a Medicare Coverage Change (Retirees and Survivors Only)

Experiencing this life event may allow you to make changes to your accident plan or health, dental, vision, or long-term care insurance.

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
ETJ0058 Request for Information (RFI)

Master Data Management (Part 2)

The Wisconsin Department of Employee Trust Funds (ETF) is seeking input from interested parties on Master Data Management (MDM). The purpose of this Request for Information (RFI) is to solicit information from qualified vendors that possess the resources and expertise to offer software licensing, hosting and implementation services for master data management.