ET-7423
Manual Other Benefit Recipient

Long-Term Care Insurance Standards

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

Statement of Incapacity for Finances and Property

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

State of Wisconsin Health Benefit Program Data Flow

Learn how the data warehouse securely collects and stores enrollment, claims, and wellness data for all participants of the Group Health Insurance Program.

Summary of Benefits and Coverage

A snapshot of a health plan's costs, benefits, covered healthcare services, and other important features.

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

Summary of Benefits and Coverage

A snapshot of a health plan's costs, benefits, covered healthcare services, and other important features.

Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits
Plan Year
  • 2025
ET-7406
Form Active Employee / Retiree / Other Benefit Recipient

Authorization to Disclose Non-Medical Information

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

Authorization to Disclose Medical Information

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.

My Benefits

With My Benefits, you can securely access your Statement of Benefits or apply for a disability retirement benefit.