Employers, use this form to verify that you viewed the employee’s original required document(s) to verify the employee or dependent(s) is eligible for benefit coverage, as administered by ETF.
Employer certification that a WRS annuity or lump-sum payment made to the survivor of the member named in this form may be eligible for an income tax exemption.
ET-4620
Form
Active Employee /
Local Employer /
State Employer
This application is intended for insured employees who are terminating private pension employment, who may qualify to continue life insurance coverage.
This manual is a reference source intended to aid employer administration of and participation in the State of Wisconsin Group Health Insurance Program.
Nine Wisconsin employers were recognized for well-being through the 2022 Well Wisconsin program. Well-being champions representing these employers were recognized at a recent Well Wisconsin Awards Ceremony held at the Olbrich Botanical Gardens in Madison, WI.