This application is intended for insured employees who are terminating private pension employment, who may qualify to continue life insurance coverage.
Events happen in life and can affect your coverage. Make sure you know when you lose your coverage and what steps to take to make sure you can keep it.
Brochure
Active Employee /
Local Employer /
State Employer
You may be able to convert your Basic group life insurance coverage to pay premiums for health insurance or long‑term care insurance. This brochure explains who is eligible and how conversion works.
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 program offers term life insurance coverage up to 5 times an employee's yearly pay for State of Wisconsin employees and local government employees whose employer offers the plan. Employees may also insure their spouses and dependent children.
The Wisconsin Public Employers Group Life Insurance program provides continuation of your group life insurance after retirement if you meet the eligibility requirements.
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.
ET-2101
Brochure
Active Employee /
Retiree /
Other Benefit Recipient
This brochure describes your group term life insurance protection and is your certificate of participation, give a valid enrollment form is on file with ETF and premiums are being paid.
