Form Active Employee / Local Employer / State Employer Health Care Provider Form Complete this form using results from your most recent health care provider visit to earn credit for the Well Wisconsin Program.
25ET-2180 Brochure Active Employee / Retiree / Other Benefit Recipient / Local Employer / State Employer 2025 Uniform Benefits Certificate of Coverage This Certificate of Coverage is your Summary Plan Description and contains the Uniform Benefits offered under the Group Health Insurance Program.
24ET-2180 Brochure Active Employee / Retiree / Other Benefit Recipient / Local Employer / State Employer 2024 Uniform Benefits Certificate of Coverage This Certificate of Coverage is your Summary Plan Description and contains the Uniform Benefits offered under the Group Health Insurance Program.
26ET-1136 Manual Local Employer / State Employer 2026 State of Wisconsin Group Health Insurance Program Agreement This 2026 State of Wisconsin Health Benefit Program Agreement is for the purposes of administering the health benefit program.
25ET-1136 Manual Local Employer / State Employer 2025 State of Wisconsin Group Health Insurance Program Agreement This 2025 State of Wisconsin Health Benefit Program Agreement is for the purposes of administering the health benefit program.
24ET-4113 Brochure Retiree / Local Employer / State Employer 2024 Medicare Plus Certificate of Coverage Certificate of Coverage for the Medicare Plus Plan for the 2024 plan year.
24ET-1136 Manual Local Employer / State Employer 2024 State of Wisconsin Group Health Insurance Program Agreement This 2024 State of Wisconsin Health Benefit Program Agreement is for the purposes of administering the health benefit program.
25ET-4113 Brochure Retiree / Local Employer / State Employer 2025 Medicare Plus Certificate of Coverage Certificate of Coverage for the Medicare Plus Plan for the 2025 plan year.
25ET-2107sbs Brochure Active Employee / Retiree / Local Employer / State Employer 2025 Schedule of Benefits: IYC Health SMP (PO1/PO6/16/PO8) The Schedule of Benefits explains what medical services the Group Health Insurance Program (GHIP) covers and what you pay for covered services.
24ET-2170sb Brochure Active Employee / Retiree / Local Employer / State Employer 2024 Schedule of Benefits: Access High Deductible Health Plan (HDHP) (PO1, PO7/17) The Schedule of Benefits explains what medical services the Group Health Insurance Program (GHIP) covers and what you pay for covered services.