State Group Health Insurance
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
Applications | 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
- Health Insurance Election for Military Service Personnel, ET-2350
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
Administered by WI Dept of Employee Trust Funds (ETF)
State Group Health Insurance - ETF Resources
Health Plans Contact Information and Directories
2009 Participating Health Plans
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
It’s Your Choice 2009, For UW Graduate Assistants, ET-2127
Standard Plan, Health Care Benefit, ET-2112
Dependent Status Certification
Coverage End Dates for Dependents
Processing Instructions and Sample Letter
Student Status Documentation Requirements
Employer Contribution Information
Leave of Absence: Employer Contribution for Insurance Premiums
Health Insurance Premiums for Less Than Full-Time Appointees
Disabled Dependent Benefit Coverage
Disabled Dependent Provisions by Plan, UW1009
Health Insurance Benefit Complaints
Insurance Complaint Form, ET-2405
You must contact your health insurance plan representative about initiating the grievance process. After the plan has issued its final determination and the problem remains unresolved; then, and only then, will the situation be reviewed by the Department of Employee Trust Funds. To initiate the Department's review, you should complete an Insurance Complaint Form (ET-2405) and return it with copies of all relevant information, including all correspondence from the insurance plan involving the complaint.