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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.

Women’s Health and Cancer Rights Act of 1998

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

Video

4 minutes

Health Coaching

Learn about Health Coaching, a well-being activity provided through Well Wisconsin. Find out what a convenient and confidential coaching session can do for you.

Department News

Nov 13, 2024 4:30pm

Photo of green tape measure, white body fat caliper, and three green capsules

GIB Examines Cost Effectiveness of Health Benefits

The Group Insurance Board today examined the cost effectiveness of bariatric surgery and adding coverage of weight-loss drugs in the State of Wisconsin Group Health Insurance Program.