Form 1095: Proof of Health Insurance The 1095 form provides documentation of your individual health insurance information. This statement is sent to you annually by your insurance provider.
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
ET-1169 Form Local Employer Existing Employer Update Resolution Wisconsin Public Employers' Group Health Insurance Program Resolution for existing local employers to updated their group health insurance program option(s).
ET-2500s Form State Employer Termination Checklist For State Employees A checklist for state employers to use when an employee is terminating for a reason other than retirement.
ET-2500l Form Local Employer Termination Checklist For Local Employees A checklist for local employers to use when an employee is terminating employment.
General Information FAQs Program Option State Employee and Retiree Health Plan & Supplemental Benefits Plan Year 2024
Benefits and Services FAQs Program Option State Employee and Retiree Health Plan & Supplemental Benefits Plan Year 2024
Network Health Major Health Systems Froedtert & the Medical College of Wisconsin Health System Children’s Hospital of Wisconsin - with locations in Milwaukee, Green Bay and Neenah Ascension Wisconsin Prevea Health Bellin Health SSM Health Holy Family Memorial Full Service Areas Brown County Calumet County Dodge County Door County Fond Du Lac County Green Lake County Kenosha County Kewaunee County Manitowoc County Marinette County Milwaukee County Oconto County Outagamie County Ozaukee County Racine County Shawano County Sheboygan County Washington County Waukesha County Winnebago County Limited Service Areas Marquette County Menominee County Portage County Waupaca County Waushara County
24ET-2168 Brochure Active Employee / Retiree / Local Employer 2024 Health Benefits Decision Guide: Local Health Plan Insurance for Employees and Retirees 2024 local health plan group health benefits decision guide for local employees and retirees.
ET-1119a Brochure State Employer State of Wisconsin Income Continuation Insurance Plan Language This plan language is intended to be used with the state and local income continuation insurance manuals.
