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
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-1109g
Manual
Active Employee /
Retiree /
Other Benefit Recipient /
Local Employer /
State Employer
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.
A benefit may be paid during your lifetime or upon your death. You or your beneficiary must make sure to follow the correct steps to receive your benefit.
