Equal Employment Opportunity Commission (EEOC) Notice Regarding Wellness Program

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-8106
Brochure Active Employee / Retiree / Local Employer / State Employer

Department of Employee Trust Funds Public Records Notice

ETF will, consistent with the state’s Public Records Law, provide information regarding ETF’s affairs, except for individual personal information restricted by statute.

ET-2405
Form Active Employee / Retiree

ETF Insurance Complaint Form

If you filed a grievance with the plan or benefit administrator and are dissatisfied with the final decision, you can request an administrative review from ETF.

ET-8108
Flyer Active Employee / Retiree / Other Benefit Recipient / Local Employer / State Employer

Nondiscrimination and Language Access

ETF complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.

Form Active Employee / Local Employer / State Employer

Health Care Provider Form

Complete this form using results from your most recent health care provider visit to earn credit for the 2021 Well Wisconsin Program. The form must be submitted by October 8, 2021.