HSA Eligibility

There are a number of requirements you must meet in order to be eligible for an HSA.

Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits
Plan Year
  • 2024
ET-4307
Form Active Employee / Retiree

Medicare Eligibility Statement

You and/or your insured dependents must be enrolled for both portions of Medicare (Hospital Part A and Medical Part B), when first eligible. Provide this information to ETF using this form.

ET-7414
Form Active Employee / Retiree / Other Benefit Recipient

Authorization to Disclose Medical Information

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.

Report Active Employee / Board Member / Local Employer / State Employer

WRS Annual Actuarial Valuation of Active Lives 2004

This report presents the annual actuarial valuations of non-retired members covered by the Wisconsin Retirement System as of December 31, 2004.

ET-4111
Form Retiree

Medicare Enrollment for Disability Retirees

If you retired due to a disability, you may be eligible for Medicare benefits. Medicare eligibility related to disability is available to persons who have received Social Security disability benefits for at least 24 months, who have End Stage Renal Disease (ESRD), or Lou Gehrig’s Disease (ALS).

Jun 30, 2012 8:00am Report Active Employee / Retiree / Other Benefit Recipient / Board Member / Local Employer / State Employer

Study of the Wisconsin Retirement System

A study of the structure of the Wisconsin Retirement System and benefits provided under the system in accordance with the 2011 Wisconsin Act 32.

Report Active Employee / Board Member / Local Employer / State Employer

WRS Annual Actuarial Valuation of Active Lives 2003

This report presents the annual actuarial valuations of non-retired members covered by the Wisconsin Retirement System as of December 31, 2003.

Report Active Employee / Board Member / Local Employer / State Employer

WRS Annual Actuarial Valuation of Active Lives 2005

This report presents the annual actuarial valuations of non-retired members covered by the Wisconsin Retirement System as of December 31, 2005.