Complete this form using results from your most recent health care provider visit to earn credit for the 2021 Well Wisconsin Program. The form must be submitted by October 8, 2021.
Employers must issue this notice to employees within 14 days of becoming aware of a qualifying event that will cause an employee to lose eligibility to participate in the FSA or limited purpose FSA program(s).
Brochure
Active Employee /
Local Employer /
State Employer
Promote upcoming Well Wisconsin webinars, seize the ZZZZ challenge, and snowshoeing workshops. Catch up on other ways Well Wisconsin is here to support employers with their employee well-being efforts.