ACA: Marketplace Health Insurance Coverage Options Notice

Program Option
  • 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-7414
Form Active Employee / Retiree / Other Benefit Recipient

Authorization to Disclose Medical Information

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.

Independent External Review

Program Option
  • 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
Video
4 minutes
Health Benefits video blank title slide.

Accident Plan

During Open Enrollment, you may have the option to enroll in accident insurance. This video will provide you with an overview of the Accident Plan and how to access your benefit information. Watch this video at your leisure on demand 24/7.

Video
11 minutes
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Well Wisconsin Program

Learn about the Well Wisconsin program, who is eligible, how to create and manage an account, and what benefits are available.

Health and Wellness News
Mar 18, 2025 5:00pm
Collage of photos of people enjoying their activities, with text, "Well Wisconsin News: March Issue"

March Well Wisconsin News

Have you read the latest Well Wisconsin News? This monthly e-newsletter has information on classes, workshops, webinars, book clubs, events, and more!

Webinar
May 27, 2025 12:00pm Event Open

Reflection through Journaling

In this engaging session, we will identify four journaling tactics and practice each one through brief journaling reflection exercises. Join Julie in this guided journaling experience. A Well Wisconsin virtual class provided by WebMD.