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Employer Dissolves

Understand what happens when your employer dissolves and you become an inactive employee.

ET-4814

Form Active Employee / Retiree / Local Employer

Local Employer Verification of Health Insurance Coverage

Local employers, complete to submit verification for an employee's or local-paid retiree's health insurance coverage.

Changes in Employment Status FAQs

Program Option

State Employee and Retiree Health Plan & Supplemental Benefits

Plan Year

2024

Appeal: Employment Category Change (Jailers)

The information pertains to an appeal by a number of employees working in county jails throughout the state (jailers) of Wisconsin. The appeal was based on their employer’s determination that they should be reported to the Wisconsin Retirement System as General Category employees instead of protective category employees with Social Security.

STAR Employers

Program Option

State Employee and Retiree Health Plan & Supplemental Benefits

Changes in Employment Status FAQs

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

Plan Year

2025

Changes in Employment Status FAQs

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

Plan Year

2024

ET-4620

Form Active Employee / Local Employer / State Employer

Employee/Employer Certification Annuitant Continuant Coverage--Private Pension Fund

This application is intended for insured employees who are terminating private pension employment, who may qualify to continue life insurance coverage.

Well Wisconsin Employer-Sponsored Activity Toolkits

Toolkits are available to help create more engagement in challenges and create a culture of well-being across your worksite.

Equal Employment Opportunity Commission (EEOC) Notice Regarding Wellness Program

Program Option

Local Annuitant Health Program (LAHP)
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