As of Sept. 23, 2017, the State of Wisconsin no longer allows the establishment of new domestic partnerships under Chapter 40 of the Wisconsin statutes. This brochure provides information about the benefit changes for established domestic partnerships.
The ICI Program is authorized by Wis. Stat. §§ 40.61 and 40.62, and is administered according to the plan provisions between the Group Insurance Board and the program’s third-party administrator.
The Wisconsin Public Employers Group Life Insurance Program is a benefit provided under the WRS and is available to employees of the State of Wisconsin and employees of participating Wisconsin local government employers.
Flyer
Active Employee /
Retiree /
Local Employer /
State Employer
Employees who did not enroll for group life insurance coverage during their initial enrollment period, or insured employees who wish to apply for more insurance for themselves or their spouse or dependents, may apply using this form.
ETF has selected Benefitfocus as the new insurance administration system. Benefitfocus offers a single, cloud-based solution that personalizes the enrollment experience and streamlines benefits administration for more than 239,000 members.
Employers, use this form to verify that you viewed the employee’s original required document(s) to verify the employee or dependent(s) is eligible for benefit coverage, as administered by ETF.
ET-2304
Form
Active Employee /
Local Employer /
State Employer