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
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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

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. The privacy of your information is important to us. Please review it carefully.

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

​​​​​​​Public Records Notices

Recognizing the people’s right to information about the government’s decision making process, the Department of Employee Trust Funds will, consistent with the state’s Public Records Law (Wis. Stat. §§ 19.31 to 19.39), provide information regarding ETF’s affairs, except for individual personal information restricted by statute.

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.

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-2311
Form Active Employee / Local Employer / State Employer

COBRA Continuation - Conversion Notice

Under federal law, known as COBRA, you and your qualified beneficiaries may continue group health insurance coverage, if eligible.

Some Out-Of-State Coverage

Medical Associates Health Plan

Major Health Systems
  • Medical Associates Clinic
  • Mercy Medical Center - Dubuque
  • Crossing Rivers Health
  • Grant Regional Health Center
  • Southwest Health Center
Full Service Areas
  • Crawford County
  • Grant County
  • Iowa County
  • Lafayette County
Limited Service Areas
  • Iowa
  • Illinois