ET-2311
Form Active Employee / Local Employer / State Employer

COBRA Continuation - Conversion Notice

Under federal law, known as COBRA, you and your qualified beneficiaries may continue group health insurance coverage, if eligible.

Flyer Active Employee / Local Employer / State Employer

Well Wisconsin Launch Flyer

The new Well Wisconsin portal is simpler, easier to use, and more customized to your personal experience. Complete a health assessment, health check, well-being activity to earn a gift card.

ET-4317
Form Active Employee / Retiree

Sick Leave Re-enrollment Application

Re-enroll for group health insurance coverage during the annual It’s Your Choice open enrollment period or after an involuntary loss of your comparable non-state coverage, if eligible.

Life Change Events and Documentation Requirements

If you are eligible to enroll in or change plans due to a qualified life change event, you may be asked to provide documents (employees to your employer, retirees to ETF) to confirm your eligibility.

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-4305
Form Active Employee / Retiree

Sick Leave Escrow Application

Apply to escrow your sick leave credits, if eligible. To escrow means to preserve or bank your sick leave credits for use at a later date.

Frequently Asked Questions

Have a question? Review the most commonly asked questions we receive.

Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits
Plan Year
  • 2025

STAR Employees Enrollment

State of Wisconsin, Legislature, and Wisconsin Court System Employees covered by STAR

Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits
Plan Year
  • 2025

Benefit Enrollment Opportunities

Learn about the times throughout the year when you may enroll in health and supplemental insurance benefits, or change your coverage.

Plan Year
  • 2025
Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits