Get Continuation-conversion Notice (et-2311) - Etf - Etf Wi

The Continuation-Conversion Notice (ET-2311) provides necessary information for users who need to elect continuation coverage under COBRA or convert to a non-group policy. This guide offers a step-by-step breakdown of how to fill out the form online, making the process straightforward and accessible for everyone.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to obtain the Continuation-Conversion Notice (ET-2311) and open it in the editing interface.
2. Review the general information section carefully. This will give you an understanding of the eligibility requirements for continuation coverage versus conversion options.
3. Fill in the Qualified Beneficiary Information section. This section requires details such as the subscriber’s member ID, social security number, name, and mailing address.
4. Check the appropriate box to indicate the coverage choice: Box A for COBRA election, Box B for COBRA during a pending disability application, Box C for converting to a non-group policy, Box D for employees eligible for immediate annuity, or Box E for state participants with 20 years of service.
5. Sign and date the form in the designated area. Ensure that you provide your daytime telephone number for any follow-up communications.
6. Submit the completed notice, along with any required health insurance applications, to the Wisconsin Department of Employee Trust Funds at the provided address. Keep a copy for your records.
7. After filing, monitor your mail for further instructions regarding premium payments and the acknowledgment of your notice from ETF.
8. You can save any changes made to the form, download a copy for your records, print it out for your convenience, or share it as needed.

Complete your Continuation-Conversion Notice (ET-2311) online today to ensure your health insurance needs are met.