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ET-5352

Form Active Employee

Income Continuation Insurance Claim Instructions

Use this form to file a paper income continuation insurance (ICI) claim.

Changes in Employment Status 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
State Employee and Retiree Health Plan & Supplemental Benefits

ET-3101

Brochure Active Employee / Retiree / Other Benefit Recipient

Separation Benefits

A separation benefit is a one-time lump-sum payment consisting only of employee contributions, additional contributions (if applicable) and accumulated interest.

ET-8947

Active Employee / Retiree / Local Employer / State Employer

Supplemental Insurance Program Fact Sheet

The State of Wisconsin Supplemental Insurance Program is an employee pay-all optional insurance program for state active employees, continuants and retirees.

My Statement of Benefits (WRS Account)

The Statement of Benefits is a summary of your WRS retirement account, available each year in mid-April. Find out why you should keep this statement handy, how to make corrections and how to request a duplicate.

Changing Health Plans 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
State Employee and Retiree Health Plan & Supplemental Benefits

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
State Employee and Retiree Health Plan & Supplemental Benefits

Appeal: Employment Category Change (Jailers)

The information pertains to an appeal by a number of employees working in county jails throughout the state (jailers) of Wisconsin. The appeal was based on their employer’s determination that they should be reported to the Wisconsin Retirement System as General Category employees instead of protective category employees with Social Security.

ET-8929

Fact Sheet Active Employee / Retiree / Local Employer / State Employer

Accumulated Sick Leave Conversion Credit Program & Supplemental Health Insurance Conversion Credit Program Fact Sheet

The ASLCC and SHICC programs were created by Wis. Stat. § 40.05 (4) (b). The ASLCC Program was first authorized in 1972; the SHICC program was first authorized in 1995.

ET-2321

Form Active Employee / Retiree

Beneficiary Designation - Alternate

If you wish to specify who shall receive a primary beneficiary’s share of a death or life insurance benefit if a primary beneficiary is deceased, you must use this alternate beneficiary designation form.