Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2025 Program Option Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits
HDHP Eligibility A few eligibility requirements include: You must be covered by a High Deductible Health Plan (HDHP) and enrolled in the Health Savings Account (HSA) offered by ETF. You cannot have any other health coverage that pays for out-of-pocket health care expenses before you meet your plan deductible (including Medicare). Program Option State Employee and Retiree Health Plan & Supplemental Benefits Plan Year 2025
HIPAA: Privacy, Electronic Transactions Standards and Security 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
You or Your Dependent Gain Eligibility for Other Group Medical Coverage Experiencing this life event may allow you to make changes to your accident plan or health, dental, vision, or long-term care insurance. 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
Your Spouse or Dependent Dies Experiencing this life event may allow you to make changes to your accident plan or health, dental, vision, or long-term care insurance. 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
Create, Submit, or Revoke A Financial Power of Attorney Document Find resources for creating a financial power of attorney document, learn how to submit your document to ETF and how to revoke your document.
ET-8800 Other Benefit Recipient Designation of Confidential and Proprietary Information New health plans should use this form to request that certain materials submitted to ETF with the New Health Plan Application be kept confidential under the Wisconsin Open Records Law.
Submit, Change, or Terminate Letters of Guardianship Learn the steps to submit, change or terminate Letters of Guardianship.