The State of Wisconsin Group Insurance Board contracts with a Pharmacy Benefit Manager to provide administrative services to State of Wisconsin and Wisconsin Public Employer group health insurance program participants.
ET-2305
Form
Active Employee /
Local Employer /
State Employer
Employees who did not enroll for group life insurance coverage during their initial enrollment period, or insured employees who wish to apply for more insurance for themselves or their spouse or dependents, may apply using this form.
ET-4427
Form
Active Employee /
Retiree /
Other Benefit Recipient
Form for the member’s physician to complete if the member cannot manage property, finances or business affairs because of an impairment in the ability to receive and evaluate information or make or communicate decisions even with the use of technological assistance.
GIB approves the issuance of a letter of intent to award contract(s) to WebMD for administering the Well Wisconsin Program, including well-being, mental health, and chronic condition management; reviews initiatives based on Healthcare Triple Aim guiding principles; sets the 2024 open enrollment period; and more.
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
