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File

ETF Insurance Complaint Form

If you filed a grievance with the plan or benefit administrator and are dissatisfied with the final decision, you can request an administrative review from ETF.

File

Request to Copy or Inspect Medical Information

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

Interactive Employer E-learning and Recorded Trainings

Group Insurance Board

item5c1.pdf

Form Active Employee / Local Employer / State Employer

Health Care Provider Form

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.

ET-1660

Form Local Employer

Local Employer Paid Life Insurance Coverage

Local employers, please submit this verification if you will be paying for an employee’s life insurance coverage in retirement.

ET-9019

Active Employee / Retiree / Local Employer / State Employer

Local Annuitant Health Program Fact Sheet

LAHP is a program that provides group health insurance for retirees whose group health insurance with their former employer does not meet their needs or is not permanently available after retirement.

ET-8902