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ET-6301

Form Other Benefit Recipient

Notice of Death

Notify the third party administrator of the group life insurance program of a member death.

You or Your Dependent Has a Medicare Coverage Change (Retirees and Survivors Only)

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-2121

Brochure Active Employee

How Part-Time Employment Affects Your WRS Benefits

This brochure explains the effect that part-time WRS employment has on your WRS retirement and other benefits.

ET-6303

Form Other Benefit Recipient

Notice of Death for Spouse or Dependent Child

Notify the third party administrator of the group life insurance program of a member's spouse or dependent death.

Changes to Life Insurance Coverage

Events happen in life and can affect your coverage. Make sure you know when you lose your coverage and what steps to take to make sure you can keep it.

ET-1660

Form Local Employer

Local Employer Paid Life Insurance Coverage

Local employers, please submit this verification if you will be paying for an employee’s life insurance coverage in retirement.

You or Your Dependent Gain Eligibility 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

Department News

Aug 14, 2024 5:00pm

Graphic design representing the types of insurance under the Group Health Insurance Program

GIB Reviews Healthcare Trends, Drug Coverage

The Group Insurance Board today reviewed trends in healthcare market consolidation and the impacts on the State of Wisconsin Group Health Insurance Program. The Board also discussed approaches for the coverage of weight-loss drugs.

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-4620

Form Active Employee / Local Employer / State Employer

Employee/Employer Certification Annuitant Continuant Coverage--Private Pension Fund

This application is intended for insured employees who are terminating private pension employment, who may qualify to continue life insurance coverage.