ET-4307
Form Active Employee / Retiree

Medicare Eligibility Statement

You and/or your insured dependents must be enrolled for both portions of Medicare (Hospital Part A and Medical Part B), when first eligible. Provide this information to ETF using this form.

Flyer Active Employee / Retiree

It’s Your Health: Diabetes

Participating in the Well Wisconsin diabetes condition management program lowers your diabetes-related prescription copays.

Find Covered Drugs and In-Network Pharmacies

Find nearby pharmacies and see which medications are covered by your plan.

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

Enroll or Make Changes

Learn how to enroll or make changes to your health insurance and supplemental benefits.

Plan Year
  • 2025
Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits

Enroll or Make Changes

Learn how to enroll or make changes to your health insurance and supplemental benefits.

Plan Year
  • 2024
Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits
et-7402
May 1, 2024 3:00pm Newsletter Retiree

WRS News for Retirees May 2024

Cover feature: A Closer Look at WRS Retirees' Impact in Wisconsin's Communities and Economy

Health Insurance Employer Forms

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.