ET-2306
Form Active Employee / Local Employer / State Employer

Conversion Information - Life Insurance

If any portion of your group life insurance coverage terminates, you may be able to continue your life insurance protection. Your right to do this is called a conversion privilege, and its features are described here.

Health and Wellness News
Sep 30, 2024 12:00pm
Doctor listening to heartbeat of child with parent

Open Enrollment Starts Today

Learn important Information on insurance benefits and other notable changes for 2025.

Your Unmarried Dependent Over Age 26 Becomes Disabled and Gains Eligibility

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
ET-4307
Form Active Employee / Retiree

Medicare Eligibility Statement

You and/or your insured dependents must be enrolled for both portions of Medicare (Hospital Part A and Medical Part B), when first eligible. Provide this information to ETF using this form.

HDHP Eligibility

A few eligibility requirements include:

You must be covered by a High Deductible Health Plan (HDHP) and enrolled in the Health Savings Account (HSA) offered by ETF.

You cannot have any other health coverage that pays for out-of-pocket health care expenses before you meet your plan deductible (including Medicare).

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

HIPAA: Special Enrollment Opportunities

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

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

Non-STAR State Employees Enrollment

Beyond Vision, Fox River Navigation System Authority, WEDC, WHEDA, WHEFA

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