This application allows you to apply to enroll in the Income Continuation Insurance (ICI) Program if you did not enroll when originally eligible or if coverage was canceled.
The Group Insurance Board today reviewed trends in healthcare market consolidation and the impacts on the State of Wisconsin Group Health Insurance Program. The Board also discussed approaches for the coverage of weight-loss drugs.
The Board moved forward with the 5% increase to the employee premium rates effective April 1, 2024. For rates effective April 1, 2023 - March 31, 2024, please see Group Life Insurance Plan Monthly Rates (ET-2164).
Use the forms on this page to administer the Group Health Insurance program. If you are not finding what you need, go to the Publications page to search through all publications.
Benefits include: Health, Wellness, Dental, Vision, Accidental Death and Dismemberment (AD&D), Long-Term Care and Pre-Tax Savings Accounts. Sign up and learn more about your health benefits.
Plan Year
2025
Program Option
State Employee and Retiree Health Plan & Supplemental Benefits
ET-2301
Form
Active Employee /
Local Employer /
State Employer