File a copy of this form with each of your former retirement systems each time you become covered under a new retirement system, for limited reciprocity between the three public employee retirement systems in Wisconsin.
ET-9019
Active Employee /
Retiree /
Local Employer /
State Employer
LAHP is a program that provides group health insurance for retirees whose group health insurance with their former employer does not meet their needs or is not permanently available after retirement.