ET-4307
Form Active Employee / Retiree

Medicare Eligibility Statement

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 and Wellness News
Oct 23, 2024 12:00pm
Doctor listening to heartbeat of child with parent

Open Enrollment Ends This Friday!

Learn about our Insurance Help page, how to contact Health Plan and Vendors, additional benefits from Delta Dental, and other mental health support programs.

Health Plan Quality

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
Plan Year
  • 2025

Find Covered Drugs and In-Network Pharmacies

Find nearby pharmacies and see which medications are covered by your plan.

Program Option
  • Local Annuitant Health Program (LAHP)
  • 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
ET-2106
Brochure Active Employee / State Employer

Income Continuation Insurance - State

The income continuation insurance ICI benefit is a voluntary “income replacement” benefit payable if you become disabled.

Enroll or Make Changes

Learn how to enroll or make changes to your health insurance and supplemental benefits.

Plan Year
  • 2025
Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits
Flyer Active Employee / Retiree

It’s Your Health: Diabetes

Participating in the Well Wisconsin diabetes condition management program lowers your diabetes-related prescription copays.