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Get WI ETF ET-2301 2019

S throughout the year when you may enroll in health insurance or change your coverage. Visit etf.wi.gov/benefits-by-employer to learn more about choices available to you, view an eLearning and see instructions on how to enroll. Return this completed form to your employer. Your health insurance deductions will be taken pre-tax unless you request they be taken post-tax. Contact your employer to make this change or submit the Employee Reimbursement Accounts Program Automatic Premium Conversion Waiv.

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