ET-2321
Form Active Employee / Retiree

Beneficiary Designation - Alternate

If you wish to specify who shall receive a primary beneficiary’s share of a death or life insurance benefit if a primary beneficiary is deceased, you must use this alternate beneficiary designation form.

ET-4110
Form Retiree

Health Insurance - Integrated with Medicare

The following information is for those retirees who are transitioning into Medicare under the State or the Wisconsin Public Employers Group Health Insurance Programs.

ET-4322
Form Active Employee / Retiree

QDRO - Military Service Certification and Affidavit 

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-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.

Employer News
Jan 18, 2022 12:00am

Local Employer Reminder: Employees Must File Timely ICI Claims

Please encourage members with ICI Program coverage who have become disabled to file an ICI claim as soon as possible after their last day worked. The effective date of an ICI benefit can be no earlier than 90 days before the claim is filed. If the member waits to file a claim, they may miss out on benefits.