Form Active Employee / Local Employer / State Employer

Health Care Provider Form

Complete this form using results from your most recent health care provider visit to earn credit for the Well Wisconsin Program.

Video
14 minutes
IYC Title Slide Background

Health Insurance & Pharmacy for Retirees

Find out how your Group Health Insurance and pharmacy benefits work. This video provides a general overview of your health benefits and how to access your health benefit program information

Some Out-Of-State Coverage

Medical Associates Health Plan

Major Health Systems
  • Medical Associates Clinic
  • Mercy Medical Center - Dubuque
  • Crossing Rivers Health
  • Grant Regional Health Center
  • Southwest Health Center
Full Service Areas
  • Crawford County
  • Grant County
  • Iowa County
  • Lafayette County
Limited Service Areas
  • Iowa
  • Illinois
ET-4110
Form Retiree

Health Insurance - Integrated with Medicare

The following information is for those retirees who are transitioning into Medicare under the State or the Wisconsin Public Employers Group Health Insurance Programs.

HealthPartners Health Plan Southeast

Major Health Systems
  • Aurora Health Care
  • Children's Wisconsin
Full Service Areas
  • Kenosha County
  • Milwaukee County
  • Ozaukee County
  • Racine County
  • Sheboygan County
  • Washington County
  • Waukesha County

Health Savings Accounts (HSAs)

Only available to participants enrolled in a High Deductible Health Plan (HDHP).

A Health Savings Account (HSA) is an individually-owned, tax-advantaged account that you can use to pay for current or future eligible medical expenses. With an HSA, you’ll have the potential to build more savings for health care expenses or additional retirement savings through self-directed investment options.

Plan Year
  • 2025
Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits
Some Out-Of-State Coverage

HealthPartners Health Plan West

Major Health Systems
  • Vibrant Health Family Clinics
  • Saint Croix Regional Medical Center
  • Essentia Health Clinic
  • HealthPartners Medical Group
  • St Luke's
Full Service Areas
  • Ashland County
  • Burnett County
  • Douglas County
  • Pierce County
  • Polk County
  • St. Croix County
  • Washburn County
  • Bayfield County
Limited Service Areas
  • Minnesota

Changing Health Plans FAQs

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
Plan Year
  • 2025