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.
ET-1904 Manual Local Employer / State Employer State of Wisconsin Department of Employee Trust Funds Section 125 Cafeteria Plan Document A resource document available for employers to obtain an understanding of the components of all benefits taken as pre-tax.
25ET-2108 Brochure Retiree / State Employer 2025 Insurance Benefits Decision Guide: State of Wisconsin Group Health Insurance for Retirees 2025 insurance benefits decision guide for state of Wisconsin retirees.
26ET-2108 Brochure Retiree / State Employer 2026 Insurance Benefits Decision Guide: State of Wisconsin Group Health Insurance for Retirees 2026 insurance benefits decision guide for state of Wisconsin retirees.
ET-2155 Form State Employer Group Health Insurance Program Continuation Application For State Employees With 20 Years of WRS-Creditable Service. Employers, complete your sections and then give the form to the employee.
26ET-1136 Manual Local Employer / State Employer 2026 State of Wisconsin Group Health Insurance Program Agreement This 2026 State of Wisconsin Health Benefit Program Agreement is for the purposes of administering the health benefit program.
25ET-1136 Manual Local Employer / State Employer 2025 State of Wisconsin Group Health Insurance Program Agreement This 2025 State of Wisconsin Health Benefit Program Agreement is for the purposes of administering the health benefit program.
Women’s Health and Cancer Rights Act of 1998 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
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 Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits
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 Deductible Health Plan (PO14) & Supplemental Benefits