ET-4307
Form Active Employee / Retiree

Medicare Eligibility Statement

You and/or your insured dependents must be enrolled for both portions of Medicare (Hospital Part A and Medical Part B), when first eligible. Provide this information to ETF using this form.

ET-8947
Active Employee / Retiree / Local Employer / State Employer

Supplemental Insurance Program Fact Sheet

The State of Wisconsin Supplemental Insurance Program is an employee pay-all optional insurance program for state active employees, continuants and retirees.

ET-1110
Manual Active Employee / Retiree / Other Benefit Recipient / Local Employer / State Employer

My Insurance Benefits HR Administrator Guide

For UWs only: This guide demonstrates procedures to help support the HR administrative duties within My Insurance Benefits and covers a variety of scenarios, such as enrollment, task management, and document management.

Report Active Employee / Retiree / Board Member / Local Employer / State Employer

Long-Term Disability Insurance Actuarial Valuation 2015

This report presents the results of the annual actuarial valuation of benefit liabilities and costs of the Long-Term Disability Insurance Plan (LTDI) as of December 31, 2015.

People kayaking

Well Wisconsin for Members

The Well Wisconsin program, administered by WebMD, provides tools and resources to help participants set health and well-being goals, track progress, stay motivated, and earn incentives.

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