Dean Health Plan - Medica West and Mayo Clinic Health System

Major Health Systems
  • Mayo Clinic
  • Mayo Clinic Health System
  • Northfield Hospital & Clinics
  • OakLeaf Clinics
  • Black River Memorial Hospital 
Full Service Areas
  • Barron County
  • Buffalo County
  • Chippewa County
  • Crawford County
  • Dunn County
  • Eau Claire County
  • Jackson County
  • La Crosse County
  • Monroe County
  • Pepin County
  • Pierce County
  • St. Croix County
  • Trempealeau County
  • Vernon County
Limited Service Areas
  • Minnesota
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.

Opt Out of Health Insurance

If you are an employee of the state, UW Hospitals and Clinics, or the Universities of Wisconsin (including Craft Workers), you may be eligible to receive up to $2,000 from your employer if you opt out of health insurance coverage under the State of Wisconsin Group Health Insurance Program.

Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits
Some Out-Of-State Coverage

Medical Associates Health Plan

Major Health Systems
  • Medical Associates Clinic
  • MercyOne Dubuque
  • Crossing Rivers Health
  • Grant Regional Health Center
  • Southwest Health Center
Full Service Areas
  • Crawford County
  • Grant County
  • Iowa County
  • Lafayette County
Limited Service Areas
  • Iowa
  • Illinois
Some Out-Of-State Coverage

Medical Associates Health Plan

Major Health Systems
  • Medical Associates Clinic
  • Mercy Medical Center - Dubuque
  • Crossing Rivers Health
  • Grant Regional Health Center
  • Southwest Health Center
Full Service Areas
  • Crawford County
  • Grant County
  • Iowa County
  • Lafayette County
Limited Service Areas
  • Iowa
  • Illinois

Health Insurance Employer Forms

Use the forms on this page to administer the Group Health Insurance program. If you are not finding what you need, go to the Publications page to search through all publications.

Webinar
Jul 16, 2025 12:00pm Event Open

Finding Relief with Kaia Health

Explore how technology can support your journey to better health and less pain. Discover Kaia Health, a new Well Wisconsin program, designed to help you manage musculoskeletal pain from the comfort of your home.

ET-4110
Form Retiree

Health Insurance - Integrated with Medicare

The following information is for those retirees who are transitioning into Medicare under the State or the Wisconsin Public Employers Group Health Insurance Programs.

Department News
Nov 10, 2025 12:00pm

Take the Health Insurance Survey

ETF wants to know about your preferences for paying for health insurance. Please complete the Group Health Insurance Program Plan Design Survey for Members by Monday, December 1, 2025.