Patient Rights and Responsibilities

As a participant in this health insurance program, you have certain rights and responsibilities. By becoming familiar with them, you will be able to make the most of your health care.

Program Option
  • 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
ETH0020 Request for Proposals (RFP)

Medicare Advantage Plans for Medicare-Enrolled Participants in the State of Wisconsin Group Health Insurance and Wisconsin Public Employer Programs

Request for Proposals (RFP) ETH0020 is issued by the Wisconsin Department of Employee Trust Funds (ETF) on behalf of the State of Wisconsin Group Insurance Board (Board). The purpose of the RFP is to provide interested and qualified vendors with information to enable them to prepare and submit competitive proposals to administer Medicare Advantage plans for Medicare-enrolled participants in the State of Wisconsin Group Health Insurance Program (GHIP) and the Wisconsin Public Employer (WPE) programs for local government employees and retirees.

ET-4322
Form Active Employee / Retiree

QDRO - Military Service Certification and Affidavit 

Wisconsin law requires the WRS participant to complete this form and submit it ETF when a portion of the participant’s account is awarded to an alternate payee via a Qualified Domestic Relations Order (QDRO).

ET-5103
Brochure Active Employee

Duty Disability and Survivor Benefits

The Duty Disability Insurance Program is an income replacement program. Duty disability benefits may be payable to protective occupation participants if you have been injured while performing your duties or contracted a disease due to your occupation.