The Wisconsin Public Employers Group Life Insurance program provides continuation of your group life insurance after retirement if you meet the eligibility requirements.
This form gives ETF and entities that perform contracted services for ETF permission to release your designated medical information to a person or entity specified by you.
A tool for an employer to confirm information was presented to a new employee, due dates identified and appropriate information and forms supplied for all ETF-administered benefits offered by the employer.
The ICI Program is authorized by Wis. Stat. §§ 40.61 and 40.62, and is administered according to the plan provisions between the Group Insurance Board and the program’s third-party administrator.
A tool for an employer to confirm information was presented to a new employee, due dates identified and appropriate information and forms supplied for all ETF-administered benefits offered by the employer.
ET-4925
Brochure
Active Employee /
Retiree /
Other Benefit Recipient