This document, “Long-Term Care Insurance Standards,” serves as a resource for insurers interested in offering state employees and retirees long-term care insurance (LTCI).
ET-4427
Form
Active Employee /
Retiree /
Other Benefit Recipient
Form for the member’s physician to complete if the member cannot manage property, finances or business affairs because of an impairment in the ability to receive and evaluate information or make or communicate decisions even with the use of technological assistance.
ET-2144
Flyer
Active Employee /
Retiree /
Other Benefit Recipient
Learn how the data warehouse securely collects and stores enrollment, claims, and wellness data for all participants of the Group Health Insurance Program.
Wisconsin law allows ETF to release personal information to a third party if the member has first provided ETF with a valid written authorization. Use this form to authorize the release of non-medical information.
ET-7414
Form
Active Employee /
Retiree /
Other Benefit Recipient
This form gives ETF and entities that perform contracted services for ETF permission to release your designated medical information to a person or entity specified by you.