This brochure describes your group term life insurance protection and is your certificate of participation, given a valid enrollment form is on file with ETF and premiums are being paid.
ET-2166
Brochure
Active Employee /
Retiree /
Other Benefit Recipient /
Board Member /
Local Employer /
State Employer
As of Sept. 23, 2017, the State of Wisconsin no longer allows the establishment of new domestic partnerships under Chapter 40 of the Wisconsin statutes. This brochure provides information about the benefit changes for established domestic partnerships.
If you retired due to a disability, you may be eligible for Medicare benefits. Medicare eligibility related to disability is available to persons who have received Social Security disability benefits for at least 24 months, who have End Stage Renal Disease (ESRD), or Lou Gehrig’s Disease (ALS).
You and/or your insured dependents must be enrolled for both portions of Medicare (Hospital Part A and Medical Part B), when first eligible. Provide this information to ETF using this form.
Health plans are evaluated on key care delivery areas such as disease management and customer satisfaction. You can use quality resources to make an informed decision about which health plan is right for you.
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