2023 Wisconsin Act 4 for County Employers

This page is a resource for county employers to learn about the implementation of 2023 Wisconsin Act 4 (Jailer Law). As the project continues, this page will be updated with more resources.

ET-2305
Form Active Employee / Local Employer / State Employer

Evidence of Insurability

Employees who did not enroll for group life insurance coverage during their initial enrollment period, or insured employees who wish to apply for more insurance for themselves or their spouse or dependents, may apply using this form.