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Create, Submit, or Revoke A Financial Power of Attorney Document

Find resources for creating a financial power of attorney document, learn how to submit your document to ETF and how to revoke your document.

ET-1906

Manual Local Employer / State Employer

State of Wisconsin Department of Employee Trust Funds Transit and Parking Plan Document

This plan document provides provisions on the Commuter Fringe Benefits Accounts, such as plan administration, eligibility, participation, and termination.

24ET-2112sb

Brochure Active Employee / Retiree / Other Benefit Recipient

2024 Schedule of Benefits: Access Plan for State of Wisconsin, Local Health Plan, LAHP (PO1, PO6/16, PO8)

The Schedule of Benefits explains what medical services the Group Health Insurance Program (GHIP) covers and what you pay for covered services.

ET-2350

Form Active Employee

Health Insurance Election for Military Service Personnel

Section 40.05 (4g), Wis. Stat., provides additional months of state contribution toward health insurance premiums for certain military service personnel who receive a military leave of absence or are eligible for reemployment under Wis. Stat. § 321.64.

ET-2301

Form Active Employee / Local Employer / State Employer

Health Insurance Application/Change Form

Enroll in health insurance or change your coverage.

Notice of Creditable Coverage for Medicare Part D

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

ET-1170

Manual State Employer

Sick Leave Conversion Program Employer Manual

This manual is a reference source intended to aid employer administration of the Accumulated Sick Leave Credit Conversion Program.

ET-1905

Manual Local Employer / State Employer

State of Wisconsin Department of Employee Trust Funds Section 125 Cafeteria Plan Summary Plan Description

This Summary Plan Description is a supplement to the Section 125 Cafeteria Plan Document (ET-1904), for members and employees. This publication summarizes the basic features of the plan.

ET-8928i

Form Local Employer

ETF Online Access Security Agreement – IAS

Employers, complete this form for access to the new Insurance Administration System (IAS).

ET-2314a

Form Local Employer / State Employer

Model COBRA Subsidy Notice

This is the Model Notice for COBRA Continuation Subsidy under the American Rescue Plan [ARP] Act of 2021. Employers please note that information for qualified beneficiaries must be completed.