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-4938
Form
Active Employee /
Retiree /
Other Benefit Recipient
To ensure accounts are being engaged with each year, ETF has set a minimum annual contribution and account balance for certain pre-tax savings accounts.
Program Option
State Employee and Retiree Health Plan & Supplemental Benefits
You must incur all eligible expenses for the 2024 benefit period by December 31, 2024. For the 2025 benefit period, you must incur all eligible expenses by December 31, 2025. The Health Savings Account (HSA) can only be used to pay for eligible medical expenses incurred after your HSA was established.
While you should always try to submit requests for distribution during the same plan year in which the expense was incurred, there is no deadline to request an HSA distribution.
All unused HSA funds carry over year-to-year without forfeiture.
Program Option
State Employee and Retiree Health Plan & Supplemental Benefits
You must incur all eligible expenses for the 2025 benefit period by December 31, 2025. For the 2026 benefit period, you must incur all eligible expenses by December 31, 2026. The Health Savings Account (HSA) can only be used to pay for eligible medical expenses incurred after your HSA was established.
While you should always try to submit requests for distribution during the same plan year in which the expense was incurred, there is no deadline to request an HSA distribution.
All unused HSA funds carry over year-to-year without forfeiture.
Program Option
State Employee and Retiree Health Plan & Supplemental Benefits