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National Medical Support Notice

Program Option

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

Health and Wellness News

Nov 19, 2024 1:00pm

Child holding a vegetable and placing it near their parent's ear. Graphic texts: WHERE YOU BELONG: Find health and closer connection. It's Your Health: Diabetes

November is National Diabetes Month

Join us this month in learning about diabetes, prediabetes, and Well Wisconsin's diabetes management coaching program.

Privacy and Policy Notices

We are committed to following legal policy and protecting the privacy of all members and visitors to our website. Please read our policy statements to understand how we protect the information that we collect, use, and share.

Notice of Privacy Practices

Program Option

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

ET-6301

Form Other Benefit Recipient

Notice of Death

Notify the third party administrator of the group life insurance program of a member death.

ET-2421

Form Active Employee / Retiree

Request to Copy or Inspect Medical Information

Use this form to request to inspect or copy medical information maintained about you by ETF.

General Privacy Notice

The Wisconsin Department of Employee Trust Funds is a state agency. ETF administers Wisconsin Retirement System and other benefits for state and local government employees. Benefits include retirement, health, and sick leave benefits; disability benefits; life insurance; income continuation insurance; and pre-tax savings accounts.

To provide you with these services, ETF maintains certain personal information about you. The purpose of this document is to help you understand what types of information we have, why we have it, and how we use and protect it.

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.

Some Out-Of-State Coverage