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.

Wisconsin's 218 Agreement with Social Security

All employers that wish to take part in the Wisconsin Retirement System must join and be covered by a Section 218 Agreement, which is an agreement between the state and the Social Security Administration (SSA) to provide Social Security coverage for state and local government employees.