ET-4560
Form Active Employee / Local Employer / State Employer

USERRA Certification

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.

Network Health

Major Health Systems

• Froedtert Health
• Children’s Hospital of Wisconsin - with locations in Milwaukee, Green Bay and Neenah
• ThedaCare
• Ascension Wisconsin
• Bellin Health
• Prevea Health
• SSM Health

Full Service Areas
  • Brown County
  • Calumet County
  • Dodge County
  • Door County
  • Fond Du Lac County
  • Green Lake County
  • Kenosha County
  • Kewaunee County
  • Manitowoc County
  • Marinette County
  • Milwaukee County
  • Oconto County
  • Outagamie County
  • Ozaukee County
  • Racine County
  • Shawano County
  • Sheboygan County
  • Washington County
  • Waukesha County
  • Winnebago County
Limited Service Areas
  • Marquette County
  • Menominee County
  • Portage County

Robin with HealthPartners Health Plan

Major Health Systems
  • Bellin Health
  • ThedaCare
  • Aurora Health Care
  • BayCare Clinic
  • Froedert & the Medical College of Wisconsin
Full Service Areas
  • Brown County
  • Calumet County
  • Fond Du Lac County
  • Green Lake County
  • Kewaunee County
  • Manitowoc County
  • Marinette County
  • Menominee County
  • Oconto County
  • Outagamie County
  • Shawano County
  • Waupaca County
  • Waushara County
  • Winnebago County
Limited Service Areas
  • Florence County
  • Marquette County

Robin with HealthPartners Health Plan

Major Health Systems
  • Bellin Health
  • ThedaCare
  • Aurora Health Care
  • BayCare Clinic
  • Froedert & the Medical College of Wisconsin
Full Service Areas
  • Brown County
  • Calumet County
  • Fond Du Lac County
  • Green Lake County
  • Kewaunee County
  • Manitowoc County
  • Marinette County
  • Menominee County
  • Oconto County
  • Outagamie County
  • Shawano County
  • Waupaca County
  • Waushara County
  • Winnebago County
Limited Service Areas
  • Florence County
  • Marquette County