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ET-2339

Form Active Employee / Retiree

Supplemental Insurance Application/Change

For UWs use only, as a paper alternative for a member who cannot complete their supplemental insurance enrollments online.

ET-1142a

Manual Active Employee / Retiree / Other Benefit Recipient / Local Employer / State Employer

UWs Member Job Aid: Effective Dates for Qualifying Life Events

For UWs only: This job aid will help employees of the UWs select the correct qualifying life event or change reason in My Insurance Benefits.

Sick Leave Credits FAQs

Find answers to common questions about the Accumulated Sick Leave Credit Conversion Program.

Program Option

State Employee and Retiree Health Plan & Supplemental Benefits

Document Requirements for Life Events and Dependent Verification

Find out which documents are required when adding a spouse or dependent to your insurance or making changes due to a qualified life event. Having the correct paperwork will help ensure a smooth update to your coverage.

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 Have a New Dependent

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

Sick Leave Credit Calculations

Learn how your sick leave credits are calculated for Accumulated Sick Leave Credit Conversion (ASLCC) and Supplemental Health Insurance Conversion Credit (SHICC).

Life Insurance Enroll and Cost

See the eligibility requirements, enrollment specifications and cost to enroll in or cancel this benefit.

Which Dental Plans Are Available to Me?

The dental plans available to you are determined by whether you are an employee or retiree and who is your current or former employer.

ET-8902

Active Employee / Retiree / Local Employer / State Employer

Group Health Insurance Fact Sheet

The group health insurance program is an employer-sponsored program offering group health coverage to employees of state agencies, UW System, UW Hospital & Clinics Authority and participating local government employers.