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
Local government employers may choose to pay for continued life insurance coverage for their employees in retirement. To do so, local employers must submit the Local Employer Paid Life Insurance Coverage (ET-1660) form.
The ICI Program is authorized by Wis. Stat. §§ 40.61 and 40.62, and is administered according to the plan provisions between the Group Insurance Board and the program’s third-party administrator.
ET-2320
Form
Active Employee /
Retiree /
Other Benefit Recipient
If you are the owner of a WRS account from which a WRS death benefit or life insurance benefit would be payable upon your death, you may file a beneficiary designation.
If any portion of your group life insurance coverage terminates, you may be able to continue your life insurance protection. Your right to do this is called a conversion privilege, and its features are described here.
If you are the owner of a WRS account from which a WRS death benefit or life insurance benefit would be payable upon your death, you may file a beneficiary designation.
ET-2305
Form
Active Employee /
Local Employer /
State Employer
Employees who did not enroll for group life insurance coverage during their initial enrollment period, or insured employees who wish to apply for more insurance for themselves or their spouse or dependents, may apply using this form.