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.
The Comprehensive Annual Financial Report of the Wisconsin Department of Employee Trust Funds for the year ended December 31, 2006 provides comprehensive information about ETF, the Wisconsin Retirement System, and other benefit programs administered by ETF.
Jun 30, 2012 8:00am Report
Active Employee /
Retiree /
Other Benefit Recipient /
Board Member /
Local Employer /
State Employer
If you are eligible to enroll in or change plans due to a qualified life change event, you may be asked to provide documents (employees to your employer, retirees to ETF) to confirm your eligibility.
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