Complete this form using results from your most recent health care provider visit to earn credit for the 2021 Well Wisconsin Program. The form must be submitted by October 8, 2021.
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.
The following information is for those retirees who are transitioning into Medicare under the State or the Wisconsin Public Employers Group Health Insurance Programs.
Find out how your Group Health Insurance and pharmacy benefits work. This video provides a general overview of your health benefits and how to access your health benefit program information
Health plans are evaluated on key care delivery areas such as disease management and customer satisfaction. You can use quality resources to make an informed decision about which health plan is right for you.
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
