ETF has updated How to Join the Wisconsin Public Employers Group Health Insurance Program (ET-1139) and How to Become a Participating Employer Under the Wisconsin Public Employer's Group Life Insurance Program (ET-1107). Please disregard any previous versions.
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.
ET-2305
Form
Active Employee /
Local Employer /
State Employer
Employees who did not enroll for group life insurance coverage during their initial enrollment period, or insured employees who wish to apply for more insurance for themselves or their spouse or dependents, may apply using this form.
A benefit may be paid during your lifetime or upon your death. You or your beneficiary must make sure to follow the correct steps to receive your benefit.
A tool for an employer to confirm information was presented to a new employee, due dates identified and appropriate information and forms supplied for all ETF-administered benefits offered by the employer.
