ET-1319 Form Local Employer / State Employer Resolution of Inclusion Under the Wisconsin Retirement System Resolution for employers to join the Wisconsin Retirement System.
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
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
ET-1139 Manual Local Employer How to Join the Wisconsin Public Employers' Group Health Insurance Program The Wisconsin Public Employers Group Health Insurance Program offers employees of local government employers the opportunity to choose between two or more health insurance plans.
ET-1325 Form Local Employer Resolution for Inclusion Under the Wisconsin Public Employers’ Group Health Insurance Program-with a request to retain a second group health plan Resolution for employers to join the WPE Group Health Insurance Program with a request to retain a second group health plan.
ET-1324 Form Local Employer Resolution for Inclusion Under the Wisconsin Public Employers’ Group Health Insurance Program Resolution for employers to join the WPE Group Health Insurance Program.
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
You Have a Job Change Where You Gain a Greater Share of Employer Contribution Toward Your Coverage (Active Employees 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 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
You Have a Job Change Where You Lose a Significant Share of Employer Contribution Toward Your Coverage (Active Employees 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 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
Enroll or Make Changes to Dental, Vision, and Accident Plan Learn when and how you can enroll or make changes to supplemental benefits, such as dental insurance, vision insurance, and the accident plan.