State Group Health Insurance
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Description: The plan provides comprehensive medical and prescription coverage. Other benefits such as dental coverage vary among plans. You can choose between a Health Maintenance Organization (HMO) and the Standard Plan (a Preferred Provider Plan). HMO plans provide coverage for an annual eye exam. The prescription drug benefit is administered by Navitus.
Premiums
Health Insurance Monthly Premiums by Employee Category
Application | Submit to your Payroll & Benefits Office
Use Adobe Reader to open and complete PDF forms.
MAC Users: Do not use "Preview", a PDF reader.
Health Insurance Application/Change Form, ET-2301
Affidavit for Insurance Purposes | Submit to your Payroll & Benefits Office
Complete this form if you are unable to provide a Social Security Number for a non-citizen spouse or non-citizen eligible dependent. Submit the Affidavit with your application.
Affidavit for Insurance Purposes, UWS 93
Learn More
State Group Health Insurance Page
Administered by WI Dept of Employee Trust Funds (ETF)
State Group Health Insurance - ETF Resources
Health Plans Contact Information and Directories
2010 Health Plan Contact Information
Health Plan Provider Directories
Pharmacy Benefits Manager
Navitus Health Solutions – Pharmacy Benefits Manager
Brochures
It’s Your Choice 2009, For State of Wisconsin Employees, ET-2107
Standard Plan, Health Care Benefit, ET-2112
