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 Well Wisconsin Program.

Department News
May 24, 2024 8:30am
Graphic image representing insurance

GIB Sets 2025 Health Insurance Program Rates

(Updated June 18, 2024) The Group Insurance Board has set premium rates for 2025, while taking action to stabilize the reserve of the State of Wisconsin Group Health Insurance Program. The Board also approved health plan service areas for the 2025 plan year at its meeting yesterday.

Video
7 minutes
Get Started with My Benefits title image.

Get Started with My Benefits

Learn how you can access My Benefits, a secure online portal that allows you to manage your benefits administered by the Department of Employee Trust Funds. This video will walk you through your first login, future sign-ins, and show you where to get assistance when needed.

Hand writing notes

Plan Designs Quick Comparison

Learn about the key differences between plan designs, such as how much you'll pay per month, how much you can expect to pay when you visit the doctor, and if you will have nationwide coverage.

Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits
Plan Year
  • 2024
Hand writing notes

Plan Designs Quick Comparison

Learn about the key differences between plan designs, such as how much you'll pay per month, how much you can expect to pay when you visit the doctor, and if you will have nationwide coverage.

Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits
Plan Year
  • 2025
ET-4317
Form Active Employee / Retiree

Sick Leave Re-enrollment Application

Re-enroll for group health insurance coverage during the annual It’s Your Choice open enrollment period or after an involuntary loss of your comparable non-state coverage, if eligible.

State and Federal Notifications

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
Health and Wellness News
Feb 25, 2025 5:00pm
Collage of photos of people enjoying their activities, with text, "Well Wisconsin News: February Issue"

My Insurance Benefits

Read the Well Wisconsin News January Issue. Know more about the launch of My Insurance Benefits in 2025

Notice of Privacy Practices

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
  • State Employee and Retiree Health Plan & Supplemental Benefits