Deferred Compensation Board

dc7ba

Network Health

Major Health Systems

• Froedtert Health
• Children’s Hospital of Wisconsin - with locations in Milwaukee, Green Bay and Neenah
• ThedaCare
• Ascension Wisconsin
• Bellin Health
• Prevea Health
• SSM Health

Full Service Areas
  • Brown County
  • Calumet County
  • Dodge County
  • Door County
  • Fond Du Lac County
  • Green Lake County
  • Kenosha County
  • Kewaunee County
  • Manitowoc County
  • Marinette County
  • Milwaukee County
  • Oconto County
  • Outagamie County
  • Ozaukee County
  • Racine County
  • Shawano County
  • Sheboygan County
  • Washington County
  • Waukesha County
  • Waupaca County
  • Waushara County
  • Winnebago County
Limited Service Areas
  • Marquette County
  • Menominee County
  • Portage County
ET-4109
Form Active Employee / Retiree

Medicare Enrollment for Retiring Employees

The following information is for employees who will retire in the next three months and will be transitioning into Medicare under the State or the Wisconsin Public Employers Group Health Insurance Programs.