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ET-7414

Form Active Employee / Retiree / Other Benefit Recipient

Authorization to Disclose Medical Information

This form gives ETF and entities that perform contracted services for ETF permission to release your designated medical information to a person or entity specified by you.

Flyer Active Employee / Retiree / Other Benefit Recipient / Board Member / Local Employer / State Employer

Hill Farms 1st Meeting Rooms-Map Only

A map of the first floor of the Hill Farms building labeled with room numbers and an arrow to the main entrance lobby.

ET-8928i

Form Local Employer

ETF Online Access Security Agreement – IAS

Employers, complete this form for access to the new Insurance Administration System (IAS).

ET-4943

Brochure Active Employee / Retiree / Other Benefit Recipient

Administrative Appeal Process

This brochure is designed to assist you in understanding the administrative appeals process as it relates to ETF. It is not intended to substitute for the legal advice or assistance of an attorney.

ET-2405

Form Active Employee / Retiree

ETF Insurance Complaint Form

If you filed a grievance with the plan or benefit administrator and are dissatisfied with the final decision, you can request an administrative review from ETF.

ET-1119

Manual State Employer

Income Continuation Insurance Administration Manual - State

The ICI Program is authorized by Wis. Stat. §§ 40.61 and 40.62, and is administered according to the plan provisions between the Group Insurance Board and the program’s third-party administrator.

ET-1145

Manual Local Employer

The Wisconsin Public Employers Income Continuation Insurance Administration Manual

The ICI Program is authorized by Wis. Stat. §§ 40.61 and 40.62, and is administered according to the plan provisions between the Group Insurance Board and the program’s third-party administrator.