File a copy of this form with each of your former retirement systems each time you become covered under a new retirement system, for limited reciprocity between the three public employee retirement systems in Wisconsin.
Report
Active Employee /
Board Member /
State Employer
This report presents the results of the annual actuarial valuation of benefit liabilities and costs of the State Income Continuation Insurance Plan as of December 31, 2022.
If any portion of your group life insurance coverage terminates, you may be able to continue your life insurance protection. Your right to do this is called a conversion privilege, and its features are described here.
ET-8947
Active Employee /
Retiree /
Local Employer /
State Employer
The State of Wisconsin Supplemental Insurance Program is an employee pay-all optional insurance program for state active employees, continuants and retirees.
Once an employee returns to work with his or her pre-military leave of absence employer, the employer is required to submit this form along with a copy of the appropriate military paperwork.
