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.
Wisconsin law allows ETF to release personal information to a third party if the member has first provided ETF with a valid written authorization. Use this form to authorize the release of non-medical information.
ET-8106
Brochure
Active Employee /
Retiree /
Local Employer /
State Employer
ETF will, consistent with the state’s Public Records Law, provide information regarding ETF’s affairs, except for individual personal information restricted by statute.
Find out which documents are required when adding a spouse or dependent to your insurance or making changes due to a qualified life event. Having the correct paperwork will help ensure a smooth update to your coverage.
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
The costs of providing care are high and demands on a caregiver's time are significant. Even if you are not a caregiver currently, there is a good chance you will be at some point in your life. Use the information and resources on this page to help you learn about caregiving and make a plan for financial security.