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.
This news for state employers provides information on 2022 insurance rates, as well as updates for the 2022 plan year. The 2022 health benefits open enrollment period is September 27 - October 22, 2021.
This news for state employers provides information on 2023 insurance rates, as well as updates for the 2023 plan year. The 2023 health benefits open enrollment period is September 26 - October 21, 2022.
Join us on December 16 to celebrate a year of success and growth! Overall Well Wisconsin participation numbers increased dramatically compared to 2020. Join us to learn more and how we’re continuing to evolve programming to meet your and your employees’ interests in 2022.
ET-7414
Form
Active Employee /
Retiree /
Other Benefit Recipient
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.
ET-4925
Brochure
Active Employee /
Retiree /
Other Benefit Recipient