ET-2106
Brochure Active Employee / State Employer

Income Continuation Insurance - State

The income continuation insurance ICI benefit is a voluntary “income replacement” benefit payable if you become disabled.

HSA Eligible Expenses

An eligible expense is a health care service, treatment, or item the IRS states can be paid for without taxes. Eligible expenses can be incurred by you, your spouse, or qualified dependents. The Health Savings Account (HSA) can only be used to pay for eligible medical expenses incurred after your HSA was established.

Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits
Plan Year
  • 2024
ET-7422
Manual Other Benefit Recipient

Supplemental Insurance Plans Guidelines

This document, “Supplemental Insurance Plan Guidelines,” or Guidelines, serves as a resource for insurers interested in offering the State of Wisconsin employees supplemental insurance plans.

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.

Cancellation or Termination of Health Coverage FAQs

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
Plan Year
  • 2024
ET-1313
Form Local Employer / State Employer

Designation of Agent

Employers, complete to designate an employee as the agent representing the employer in matters pertaining to the programs administered by the Department of Employee Trust Funds.