Form Active Employee / Local Employer / State Employer Health Care Provider Form Complete this form using results from your most recent health care provider visit to earn credit for the Well Wisconsin Program.
26ET-1136 Manual Local Employer / State Employer 2026 State of Wisconsin Group Health Insurance Program Agreement This 2026 State of Wisconsin Health Benefit Program Agreement is for the purposes of administering the health benefit program.
24ET-1136 Manual Local Employer / State Employer 2024 State of Wisconsin Group Health Insurance Program Agreement This 2024 State of Wisconsin Health Benefit Program Agreement is for the purposes of administering the health benefit program.