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Form 1095: Proof of Health Insurance

The 1095 form provides documentation of your individual health insurance information. This statement is sent to you annually by your insurance provider.

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

Publication / ET-form

et2314a

ET-1144

Manual Local Employer

Local Employer Health Insurance Standards, Guidelines and Administration Manual

This manual is a reference source intended to aid employer administration of and participation in the WPE Group Health Insurance 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.

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-1118

Manual State Employer

State Agency Health Insurance Standards, Guidelines and Administration Employer Manual

This manual is a reference source intended to aid employer administration of and participation in the State of Wisconsin Group Health Insurance Program.