ET-2101
Brochure Active Employee / Retiree / Other Benefit Recipient

The Wisconsin Public Employers Group Life Insurance Program

This brochure describes your group term life insurance protection and is your certificate of participation, give a valid enrollment form is on file with ETF and premiums are being paid.

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.

ET-4925
Brochure Active Employee / Retiree / Other Benefit Recipient

How Divorce Can Affect Your WRS Benefits

Information on how a divorce may affect WRS benefits, beneficiary designations as well as information for the alternate payee.