ET-1518
Form State Employer

Flexible Spending Account Continuation Election Form

Employers must issue this notice to employees within 14 days of becoming aware of a qualifying event that will cause an employee to lose eligibility to participate in the FSA or limited purpose FSA program(s).

W-2 Wellness Incentive Taxes

Income received from the WebMD program or the Wellness Incentive from your health plan provider is taxable. You will receive a W-2 statement from ETF if you are covered under the state group health insurance program and you and/or your dependents received a wellness incentive from your health plan provider or from WebMD.

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
Flyer Active Employee / Local Employer / State Employer

Well Wisconsin Challenge: Kindness at Work

Join us in monthly activities to promote kindness, self-compassion, and overall well-being with the Random Acts of Kindness at Work Calendar.

ET-4317
Form Active Employee / Retiree

Sick Leave Re-enrollment Application

Re-enroll for group health insurance coverage during the annual It’s Your Choice open enrollment period or after an involuntary loss of your comparable non-state coverage, if eligible.