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Benefit Program

  • Group Health Insurance
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ET-2314
Form Local Employer / State Employer

Request for Treatment as an Assistance Eligible Individual

The American Rescue Plan Act of 2021 (ARP) subsidizes the full COBRA premium for “Assistance Eligible Individuals” for periods of coverage from April 1, 2021 through September 30, 2021.

Program Payment Due Dates

Premium and contribution payment deadlines for ETF-administered programs.

Report Active Employee / Board Member / Local Employer

Local Income Continuation Insurance Plan Actuarial Valuation 2004

This report presents the results of the annual actuarial valuation of benefit liabilities and costs of the Local Income Continuation Insurance Plan as of December 31, 2004.

Report Active Employee / Board Member / Local Employer

Local Income Continuation Insurance Plan Actuarial Valuation 2005

This report presents the results of the annual actuarial valuation of benefit liabilities and costs of the Local Income Continuation Insurance Plan as of December 31, 2005.

Form Local Employer / State Employer

Supplemental Dental Retiree/Continuant Change Form 2020

This is a form a retiree/continuant would use if there is a change in their Delta dental supplemental coverage because of a life event.

Employer News
Apr 18, 2024 11:00am

April Well Wisconsin: Health Screenings, Culture, Champion Contest, and Webinars

Spread the word about the regional biometric health screening events, participate in the culture of health assessment and champion contest, and promote upcoming webinars and 5K workshops.

ET-1152
Form Local Employer

Existing Employer Option Selection Resolution WPE Health Insurance

A resolution for the employer to offer the Wisconsin Public Employers Group Health Insurance program to eligible personnel through the program of the State of Wisconsin Group Insurance Board, and agrees to abide by the terms of the program.

ET-1904
Manual Local Employer / State Employer

State of Wisconsin Department of Employee Trust Funds Section 125 Cafeteria Plan Document

A resource document available for employers to obtain an understanding of the components of all benefits taken as pre-tax.

ET-1109g
Manual Active Employee / Retiree / Other Benefit Recipient / Local Employer / State Employer

My Insurance Benefits Glossary of Terms and Definitions

This document for employers provides a list of My Insurance Benefits terms and definitions.

Employer News
May 14, 2024 7:30am

Local Health Insurance Manual (ET-1144) Revised May 2024

The local health insurance manual (ET-1144) has been revised. Please disregard any previous versions of this manual. Changes are summarized here.

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