Wisconsin Department of Employee Trust Funds PO Box 7931 Madison WI 537077931Health Insurance Application/Change18775335020 (toll free) Fax 6082674549 etf.wi.govThere are certain times throughout.
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How to fill out the WI ETF ET-2301 online
The WI ETF ET-2301 form is essential for applying for or changing health insurance coverage through the Wisconsin Department of Employee Trust Funds. This guide provides step-by-step instructions to assist users in completing the form accurately and efficiently online.
Follow the steps to complete the WI ETF ET-2301 form online.
- Click ‘Get Form’ button to access the WI ETF ET-2301 form and open it in the online editor.
- Begin by providing the applicant information in Section 1. Enter your name, address, contact details, and ETF ID where required. Ensure that you indicate any changes to personal information as necessary.
- If you are adding a spouse to your plan, complete Section 2 with their details, including name, birth date, and gender. Be sure to check for any changes to spouse information.
- In Section 3, add dependent information if applicable. List the names of any dependents you wish to cover, along with their pertinent details such as birth dates and relation to you.
- Proceed to Section 4 to confirm your eligibility and state the reason for your application or changes. Select the appropriate reason for enrolling or making changes from the options provided.
- In Section 5, select your health plan design. Review available plan options and make your choice accordingly, including whether you want dental coverage.
- Complete Section 6 by choosing a health plan. Ensure you select a provider suited to your needs based on coverage and availability.
- If applicable, provide details in Section 7 regarding Medicare coverage for yourself or your dependents.
- If you need to remove a spouse or dependent, fill out Section 8, providing their names and relevant details.
- Complete any necessary sections if changing from family to individual coverage or canceling coverage in Sections 9 and 10 as needed.
- If you have other health insurance, declare this in Section 11 and provide the required information.
- Review the terms and conditions carefully before proceeding. Then, ensure you sign and date the application in Section 13 to affirm your understanding and agreement.
- Once you have filled out all relevant sections, save your changes, download your form, print it, or share it with applicable parties as required.
Start completing your WI ETF ET-2301 form online today to ensure your health insurance needs are met.
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