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Authorization Forms
Authorization to Disclose Medical Information (ET-7414)
Request to Copy or Inspect Medical Information (ET-2421)
Disability Insurance Forms
Disability Benefits Folder (ET-5107)
Income Tax Withholding Election (ET-4310)
Long-Term Disability Insurance Folder (ET-5108)
s. 40.65 Duty Disability and Survivor Benefits (ET-5103)
Addendum - Traditional HMO - Standard PPP Program Option 3 (ET-2157)
Addendum - Deductible HMO - Deductible Standard Plan Program Option 4 (ET-2158)
Addendum - Deductible HMO - Deductible Standard PPP Program Option 5 (ET-2159)
Group Health Insurance (ET-4112)
Group Health Insurance Application/Change Form (ET-2301)
It's Your Choice 2012 - State Employees, Annuitants and Continuants and Graduate Assistants - Decision Guide (ET-2107d-12)
It's Your Choice 2011 - State Employees, Annuitants and Continuants and Graduate Assistants - Decision Guide (ET-2107d-11)
It's Your Choice 2010 - State Employees, Annuitants and Continuants and Graduate Assistants - Decision Guide (ET-2107d-10)
It's Your Choice 2012 - State Employees, Annuitants and Continuants and Graduate Assistants - Reference Book (ET-2107r-12)
It's Your Choice 2011 - State Employees, Annuitants and Continuants and Graduate Assistants - Reference Book (ET-2107r-11)
It's Your Choice 2010 - State Employees, Annuitants and Continuants and Graduate Assistants - Reference Book (ET-2107r-10)
It's Your Choice 2012 - Wisconsin Public Employees (Local Government Employees and Annuitants) - Decision Guide (ET-2128d-12)
It's Your Choice 2011 - Wisconsin Public Employees (Local Government Employees and Annuitants) - Decision Guide (ET-2128d-11)
It's Your Choice 2010 - Wisconsin Public Employees (Local Government Employees and Annuitants) - Decision Guide (ET-2128d-10)
It's Your Choice 2012 - Wisconsin Public Employees (Local Government Employees and Annuitants) - Reference Book (ET-2128r-12)
It's Your Choice 2011 - Wisconsin Public Employees (Local Government Employees and Annuitants) - Reference Book (ET-2128r-11)
It's Your Choice 2010 - Wisconsin Public Employees (Local Government Employees and Annuitants) - Reference Book (ET-2128r-10)
Local Annuitant Health Program - 2011 (ET-9019)
Medicare Eligibility Statement (ET-4307)
Sick Leave Conversion Credit Brochure (ET-4132)
Sick Leave Escrow Application (ET-4305)
Sick Leave Re-enrollment Application (ET-4317)
Standard Plan - State Employees (ET-2112)
State Medicare Plus (ET-4113)
WPE Standard Plan Booklet (ET-2131)
WPE Standard PPP Plan Booklet (ET-2160)
WPE Deductible Standard Plan Booklet (ET-2161)
WPE Deductible Standard PPP Plan Booklet (ET-2162)
WPE SMP Plan Booklet (ET-2165)
WPE Deductible SMP Plan Booklet (ET-2163)
Income Continuation Insurance - Local (ET-2129) There will be a premium holiday in 2012 for local ICI participants.
Income Continuation Insurance - State (ET-2106)
Income Continuation Insurance Application-State (ET-2307)
Income Continuation Insurance Application-Local (ET-2366)
ICI Plan Language - State and Local Government
Beneficiary Designation (ET-2320)
Conversion Information - Life Insurance (ET-2306)
Converting Your Group Life Insurance to Pay Health or Long-Term Care Insurance Premiums (ET-2325)
Evidence of Insurability (ET-2305)
Group Life Insurance After You Terminate Employment (ET-4104)
Group Life Insurance Plan Monthly Rates-2010-2011 (ET-2164)
Life Insurance Application/Cancellation/Refusal (ET-2304)
Life Suite
Beneficiary Financial Counseling Will Preparation and Legal Services Travel Assistance Legacy Planning Services
Beneficiary Financial Counseling
Will Preparation and Legal Services
Travel Assistance
Legacy Planning Services
Living Benefits Brochure (ET-2327)
Notice of Death for Spouse or Dependent Child (ET-6303)
Wisconsin Public Employers Group Life Insurance Plan (ET-2101)
ETF Insurance Complaint Form (ET-2405)
Ombudsperson Services Fact Sheet (ET-8934)
Ombudsperson Program Brochure (ET-8935)
