25ET-2131sb Brochure Active Employee / Retiree / Local Employer 2025 Schedule of Benefits: Local Traditional Access Plan (PO2/12) The Schedule of Benefits explains what medical services the Group Health Insurance Program (GHIP) covers and what you pay for covered services.
24ET-2131sb Brochure Active Employee / Retiree / Local Employer 2024 Schedule of Benefits: Local Traditional Access Plan (PO2/12) The Schedule of Benefits explains what medical services the Group Health Insurance Program (GHIP) covers and what you pay for covered services.
Health & Pharmacy Information about your health benefits offered through the State of Wisconsin Group Health Insurance Program 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
Network Health Major Health Systems Froedtert & the Medical College of Wisconsin Health System Children’s Hospital of Wisconsin - with locations in Milwaukee, Green Bay and Neenah Ascension Wisconsin Prevea Health Bellin Health SSM Health Holy Family Memorial 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 Waupaca County Waushara County
You or Your Dependent Involuntarily Lose Eligibility or All Employer Contribution for Other Group Medical Coverage Experiencing this life event may allow you to make changes to your accident plan or health, dental, vision, or long-term care insurance. 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-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.
