Summary of Benefits and Coverage A snapshot of a health plan's costs, benefits, covered healthcare services, and other important features. Plan Year 2026 Program Option Local Annuitant Health Program (LAHP)
You or Your Dependent Gain Eligibility for Other Group Medical Coverage 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-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.
Uniform Dental Benefits Certificate of Coverage Program Option Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits State Employee and Retiree Health Plan & Supplemental Benefits Plan Year 2025
Uniform Dental Benefits Certificate of Coverage Program Option Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits State Employee and Retiree Health Plan & Supplemental Benefits Plan Year 2026