The WRS covers employees of the state of Wisconsin and employees of local government employers who elect to participate, and Milwaukee Public School District teachers.
The following information is for those retirees who are transitioning into Medicare under the State or the Wisconsin Public Employers Group Health Insurance Programs.
Wisconsin law requires the WRS participant to complete this form and submit it ETF when a portion of the participant’s account is awarded to an alternate payee via a Qualified Domestic Relations Order (QDRO).
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.
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
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.
The Comprehensive Annual Financial Report of the Wisconsin Department of Employee Trust Funds for the year ended December 31, 2006 provides comprehensive information about ETF, the Wisconsin Retirement System, and other benefit programs administered by ETF.
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).