A tool for an employer to confirm information was presented to a new employee, due dates identified and appropriate information and forms supplied for all ETF-administered benefits offered by the employer.
ET-4943
Brochure
Active Employee /
Retiree /
Other Benefit Recipient
This brochure is designed to assist you in understanding the administrative appeals process as it relates to ETF. It is not intended to substitute for the legal advice or assistance of an attorney.
If you are eligible to enroll in or change plans due to a qualified life change event, you may be asked to provide documents (employees to your employer, retirees to ETF) to confirm your eligibility.
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
ET-2305
Form
Active Employee /
Local Employer /
State Employer
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.
Benefits Mentor is the interactive benefits counselor for active state employees and non-Medicare retirees. Powered by ETF’s secure data warehouse, Benefits Mentor will use your claims information (if available) as a basis for personalized plan design recommendations.
Program Option
State Employee and Retiree Health Plan & Supplemental Benefits
With summer right around the corner, Well Wisconsin is providing employers with the latest resources and activities to promote in June. Activities include the Five to Thrive fruit and veggies challenge, a cool crunch for those warm summer months, and the June inclusiveness calendar activities.
The American Rescue Plan Act (ARP) provides for temporary 100% COBRA premium subsidies for eligible former employees who suffered an involuntary job loss, and for current or former employees who have suffered a reduction in hours that made them COBRA-eligible. A member might qualify both to use their sick leave in retirement and for the COBRA subsidy.
ET-2101
Brochure
Active Employee /
Retiree /
Other Benefit Recipient
This brochure describes your group term life insurance protection and is your certificate of participation, give a valid enrollment form is on file with ETF and premiums are being paid.
ET-2166
Brochure
Active Employee /
Retiree /
Other Benefit Recipient /
Board Member /
Local Employer /
State Employer
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.
The Group Health Benefits Annual Report includes goals and results for different health benefit offerings. The report will be updated yearly to track progress.
