ET-1158
Manual Local Employer / State Employer

State of Wisconsin Supplemental Benefit Plans Administration Manual

Supplemental Benefit Plans are types of insurance that are generally supplementary to group health insurance, providing coverage for dental, vision, accidental injury, or accidental death and voluntary for eligible employees and retirees.

State and Federal Notifications

Program Option
  • Local Annuitant Health Program (LAHP)
  • 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-7422
Manual Other Benefit Recipient

Supplemental Insurance Plans Guidelines

This document, “Supplemental Insurance Plan Guidelines,” or Guidelines, serves as a resource for insurers interested in offering the State of Wisconsin employees supplemental insurance plans.

Financial Power of Attorney

Your WRS account information is confidential, and no one can receive information about or make changes to your account unless authorized. You can authorize another person to make changes to your account by submitting a financial power of attorney document to ETF.

ET-2405
Form Active Employee / Retiree

ETF Insurance Complaint Form

If you filed a grievance with the plan or benefit administrator and are dissatisfied with the final decision, you can request an administrative review from ETF.

Form Active Employee / Local Employer / State Employer

Health Care Provider Form

Complete this form using results from your most recent health care provider visit to earn credit for the Well Wisconsin Program.