ET-2314a
Form Local Employer / State Employer

Model COBRA Subsidy Notice

This is the Model Notice for COBRA Continuation Subsidy under the American Rescue Plan [ARP] Act of 2021. Employers please note that information for qualified beneficiaries must be completed. 

ET-2311
Form Active Employee / Local Employer / State Employer

COBRA Continuation - Conversion Notice

Under federal law, known as COBRA, you and your qualified beneficiaries may continue group health insurance coverage, if eligible.

ET-1158
Manual Local Employer / State Employer

State of Wisconsin Supplemental Benefit Plans Administration Manual

Supplemental Benefit Plans are types of insurance that are generally supplementary to group health insurance, providing coverage for dental, vision, accidental injury, or accidental death and voluntary for eligible employees and retirees.

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.