Notice of Creditable Coverage for Medicare Part D Program Option 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
COBRA: Continuation of Coverage Rights for the Group Health Insurance Program Program Option 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-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.
ET-4814 Form Active Employee / Retiree / Local Employer Local Employer Verification of Health Insurance Coverage Local employers, complete to submit verification for an employee's or local-paid retiree's health insurance coverage.
ET-2301 Form Active Employee / Local Employer / State Employer Health Insurance Application/Change Form Enroll in health insurance or change your coverage.
Brochure Active Employee / Local Employer / State Employer Well Wisconsin Program Brochure See information on the Well Wisconsin Program with WebMD.
Medicare Information FAQs Program Option State Employee and Retiree Health Plan & Supplemental Benefits Plan Year 2024
24ET-2180 Brochure Active Employee / Retiree / Other Benefit Recipient / Local Employer / State Employer 2024 Uniform Benefits Certificate of Coverage This Certificate of Coverage is your Summary Plan Description and contains the Uniform Benefits offered under the Group Health Insurance Program.
23ET-2180 Brochure Active Employee / Retiree / Other Benefit Recipient / Local Employer / State Employer 2023 Uniform Benefits Certificate of Coverage This Certificate of Coverage is your Summary Plan Description and contains the Uniform Benefits offered under the Group Health Insurance Program.