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.

ET-2154
Form Active Employee / Local Employer / State Employer

Group Life Insurance Continuation Application

This application is intended for insured employees who are terminating Wisconsin Retirement System employment, who may qualify to continue life insurance coverage, and who will not begin a WRS retirement benefit immediately.