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).
ET-2321
Form
Active Employee /
Retiree /
Other Benefit Recipient
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.
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.
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
If you are eligible to enroll in or change plans due to a qualified life change event, you may be asked to provide documents (employees to your employer, retirees to ETF) to confirm your eligibility.
Program Option
Local Annuitant Health Program (LAHP)
Local Deductible Health Plan (PO14) & Supplemental Benefits
Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits
Local Health Plan (PO16) & Supplemental Benefits
Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits
Local High Deductible Health Plan (PO17) & Supplemental Benefits
Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits
Local Traditional Health Plan (PO12) & Supplemental Benefits
Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits
State Employee and Retiree Health Plan & Supplemental Benefits
Report
Active Employee /
Retiree /
Other Benefit Recipient /
Board Member /
Local Employer /
State Employer