ET-1908
Form Local Employer / State Employer

Employer Attestation For Documentation Received

Employers, use this form to verify that you viewed the employee’s original required document(s) to verify the employee or dependent(s) is eligible for benefit coverage, as administered by ETF.

Divisions and Offices

Profiles of each of the directors of divisions and offices of the State of Wisconsin Department of Employee Trust Funds.

Some Out-Of-State Coverage

Dean Health Plan

Major Health Systems
  • SSM Health Hospitals and Clinics (Dean Medical Group, Fond du Lac Regional and Monroe Clinics)
  • Prairie Ridge Health Hospital & Clinics
  • Fort HealthCare Hospital & Clinics
  • Sauk Prairie Healthcare Hospital & Clinics
  • Southwest Health Hospital & Clinics
Full Service Areas
  • Adams County
  • Columbia County
  • Crawford County
  • Dane County
  • Dodge County
  • Fond Du Lac County
  • Grant County
  • Green County
  • Green Lake County
  • Iowa County
  • Jefferson County
  • Juneau County
  • Lafayette County
  • Richland County
  • Rock County
  • Sauk County
  • Vernon County
  • Waukesha County
Limited Service Areas
  • Marquette County
  • Walworth County
  • Illinois
  • Iowa
24ET-2180
Brochure Active Employee / Retiree / Other Benefit Recipient / Local Employer / State Employer

2024 Uniform Benefits Certificate of Coverage

This Certificate of Coverage is your Summary Plan Description and contains the Uniform Benefits offered under the Group Health Insurance Program.

25ET-2180
Brochure Active Employee / Retiree / Other Benefit Recipient / Local Employer / State Employer

2025 Uniform Benefits Certificate of Coverage

This Certificate of Coverage is your Summary Plan Description and contains the Uniform Benefits offered under the Group Health Insurance Program.

Group Retirement Appointment
Oct 14, 2025 9:30am West Bend, WI Event Open

Group Retirement Appointment

A benefits specialist will be in your area to conduct group appointments. Bring your Retirement Benefit Estimates and Application (ET-4301) which you receive from ETF. Several topics will be discussed at this 2½ hour appointment.

Group Retirement Appointment
Oct 14, 2025 1:30pm West Bend, WI Event Open

Group Retirement Appointment

A benefits specialist will be in your area to conduct group appointments. Bring your Retirement Benefit Estimates and Application (ET-4301) which you receive from ETF. Several topics will be discussed at this 2½ hour appointment.

Group Retirement Appointment
Oct 22, 2025 10:00am Oshkosh, WI Event Open

Group Retirement Appointment

A benefits specialist will be in your area to conduct group appointments. Bring your Retirement Benefit Estimates and Application (ET-4301) which you receive from ETF. Several topics will be discussed at this 2½ hour appointment.