This form gives ETF and entities that perform contracted services for ETF permission to release your designated medical information to a person or entity specified by you.
The Well Wisconsin program, administered by WebMD, provides tools and resources to help participants set health and well-being goals, track progress, stay motivated, and earn incentives.
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
Employers should always protect member personal identifiable information. What counts as personal member information? How can employers protect sensitive data? ETF has published a new training video that helps answer these questions.
Brochure
Active Employee /
Local Employer /
State Employer
