Benefits Administration
Employer Forms
Employees initiate an appeal or rescind their benefit plan election electronically by following the steps provided in the ABE Appeals Tip sheet. The deadlines for 2024 Annual Benefits Enrollment appeals and rescinds are listed below. It is recommended that employees submit their appeal or rescind their election as soon as an issue is discovered and not wait until the deadlines.
- Rescinds (for all plans listed below): December 31, 2023
- Appeals:
- Flexible Spending Accounts (Health Care and Dependent Day Care): January 31, 2024
- Supplemental Insurance Plans (Dental, Vision, Accident): February 29, 2024
- State Group Health Insurance (Uniform Dental, Health Opt-Out Incentive, Health Savings Account): April 15, 2024
Employees may appeal or rescind only if they were actively employed with the UW System during the ABE period.
Based on the volume of appeals received, a final decision on an appeal can take up to 60 days from the date the appeal is received in good order. Employee will be notified by UW-Shared Services, Service Operations directly when their appeal has been approved or denied. When working with employees on their appeal please advise them of this information.
- - Upon receipt and review of an employee's request for Catastrophic Leave, the employer shall complete this form to indicate approval/denial and forward to the Payroll Office for processing.
Continuation and conversion forms can be accessed below for reference. Employees should contact UW-Shared Services, Service Operations at serviceoperations@uwss.wisconsin.edu or (888) 298-0141 (7:45-4:30 p.m. Monday-Friday) to obtain continuation and conversion forms.
- - This form must be provided to an employee within 5 business days of an employee’s request for a WFMLA and/or FMLA-protected leave; or within 5 business days of learning an employee is eligible for coverage by WFMLA and/or FMLA.
- - This form must be provided to the employee who has requested a WFMLA and/or FMLA-protected leave to let the employee know if the leave is approved and/or if the employee needs to submit any additional information before the leave can be approved.
- - Complete this form if you (the employer) needs to obtain medical information directly from the health care provider.
ETF requires online submission of Sick Leave Conversion Credits through the online Accumulated Sick Leave System in the 'myETF Benefits Administrator' system. The online sick leave certification process provided through ETF’s system must be used for all employees. To request access review .
Additional Information and Tools
Resources
- State Group Health Insurance Manual - Chapter 12 - Accumulated Sick Leave Conversion Credits (ASLCC)
- UW System Administrative Policy 1212 (formerly BN 3): Sick Leave
- Sick Leave Credit Conversion Program Estimator
Training
- Sick Leave Credit Conversion Program Training - Webinar series available for viewing anytime. Registration required. Published by ETF.
- Module 1 - Provides an overview of the sick leave program, eligibility requirements and sick leave conversion credit calculations.
- Module 2 - Discusses employer and employee responsibilities, and when employers are to certify sick leave for their employees.
- Module 3 - Explains rehired annuitants, sick leave escrow, the sick leave re-enrollment process and what happens to a member’s sick leave in the event of death.
- Module 4 - Resources to assist employers helping employees considering terminating employment and the Q & A from the Sick Leave Credit Conversion Program in-person employer training.
Information on scheduling WDC presentations at your institution.
Information including a list of frequently asked questions and the application can be found on the WRS-Single Payroll Transition Program web page.
Review the
for information on program responsibilities.To schedule an Edvest workshop on your campus, contact the Wisconsin Department of Financial Institutions (DFI) College Savings Program Representatives:
- Linda Lambert (linda.lambert@dfi.wisconsin.gov)
- Jessica Wetzel (jessica.wetzel@dfi.wisconsin.gov)
Employee Forms
Forms
Resources
- Benefits Mentor (an interactive virtual benefits counselor)
- Glossary of Health Coverage and Medical Terms
- Guide to Office Visit Copays
- Health Benefits Decision Guide
- Health Plan Search
- How to Get Care When You Need It eLearning (ETF)
- Patient Rights and Responsibilities
- Plan Design Options eLearning (ETF)
- Preventive Health Services
- State & Federal Notifications
- Summary of Benefits & Coverage
- Terms and Conditions
- Affordable Care Act (ACA)
- Health Insurance Marketplace Notice
Certificate of Coverage
Plan Administrators
- State Group Health Insurance: Department of Employee Trust Funds | (877) 533-5020
- Pharmacy Benefits: Navitus Health Solutions | (866) 333-2757
- Well Wisconsin Program: WebMD | (800) 821-6591
last updated: 10/19/2023
- Terms and Conditions
- DeltaVision/EyeMed | (855) 544-6035 | Find a Provider
- State Group Life Insurance Application/Cancellation/Refusal (ET-2304)
- State Group Life Insurance Certificate of Coverage (ET-2101)
- State Group Life Insurance Living Benefits Brochure (ET-2327)
- State Group Life Insurance Medical Evidence of Insurability Form (ET-2305)
- Conversion Form: Contact UW-Shared Services, Service Operations at serviceoperations@support.wisconsin.edu or (888) 298-0141 (7:45-4:30 p.m. Monday-Friday) to obtain a conversion form.
- Continuation Form: Contact your institution benefits contact if you need a continuation form (continuation at retirement is automatic).
- Conversion Form: Contact UW-Shared Services, Service Operations at serviceoperations@support.wisconsin.edu or (888) 298-0141 (7:45-4:30 p.m. Monday-Friday) to obtain a conversion form.
- Conversion Form: Contact UW-Shared Services, Service Operations at serviceoperations@support.wisconsin.edu or (888) 298-0141 (7:45-4:30 p.m. Monday-Friday) to obtain a conversion form.
- Conversion Form: Contact UW-Shared Services, Service Operations at serviceoperations@support.wisconsin.edu or (888) 298-0141 (7:45-4:30 p.m. Monday-Friday) to obtain a conversion form.
- (Policy number is GTU8364005)
- Continuation and Conversion Forms: Contact UW-Shared Services, Service Operations at serviceoperations@support.wisconsin.edu or (888) 298-0141 (7:45-4:30 p.m. Monday-Friday) to obtain a continuation or conversion form.
- Continuation Form: Contact UW-Shared Services, Service Operations at serviceoperations@support.wisconsin.edu or (888) 298-0141 (7:45-4:30 p.m. Monday-Friday) if you need a continuation form.
- Terms and Conditions
- Securian | (866) 295-8690
Flexible Spending Accounts (FSAs)
- Automatic Premium Conversion Waiver (ET-2340)
- IRS Publication 502: Medical and Dental Expenses
- Healthcare FSA Unsubstantiated Claims Process web page
Health Savings Accounts (HSAs)
An HSA is available to individuals enrolled in a High Deductible Health Plan (HDHP) through the UW System; it is a required component of the HDHP.
- IRS Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans
- Automatic Premium Conversion Waiver (ET-2340)
Plan Administrator
- Optum | (833) 881-8158
- WRS Fact Sheet (ET-8901)
- Benefit Handbook (ET-2119)
- Variable Trust Fund Brochure (ET-4930)
- Election to Participate in the Variable Fund (ET-2356)
- Canceling Variable Participation (ET-2313)
- Additional Contributions Brochure (ET-2123)
- Maximum Additional Contribution Worksheet (ET-2566)
- Buying Creditable Services Brochure (ET-4121)
- Buying Other Governmental Service Brochure (ET-2207)
- Separation Benefits Brochure (ET-3101)
- WRS Guide to Retirement Brochure (ET-4133)
- Choosing an Annuity Option Brochure (ET-4117)
- Applying for Your Retirement Benefit Brochure (ET-4106)
- Calculating Your Retirement Benefits Brochure (ET-4107)
- ETF Retirement Estimate Request
- Retirement Estimate Request (ET-4207)
- Tax Liability on WRS Benefits (ET-4125)
- How Divorce Can Affect Your WRS Benefits Brochure (ET-4925)
- Disability Retirement Benefits Brochure (ET-5107)
- Duty Disability and Survivor Benefits Brochure (ET-5103)
- Death Benefits Brochure (ET-6101)
- Military Service and Your WRS Benefits
Plan documents
EZ Enrollment Form
Paper Applications
Salary Reduction Agreement
Other Resources
WDC accounts can be managed online, over the phone, or with a local WDC Retirement Plan Advisor.
- Online: www.wdc457.org
- The following can be found on the WDC website without logging in:
- After logging into your WDC account, you may:
- Update your contribution election
- Submit or change your beneficiary
- Consolidate accounts
- Aggregate your outside accounts to obtain your net worth and review your holistic financial picture
- Get help budgeting and/or information about emergency savings
- Review your probability of retiring when you want to
- Update your account information, such as address, username, and password
- After logging into your WDC account, you may:
- By Phone:
- WDC representatives are available Monday through Friday between 7 am and 9 pm, and Saturday between 8 am and 4:30 pm at (877) 457-9327. Press 0 and follow the prompts to speak to a representative.
- For local assistance in Madison, answer ‘yes’ to the prompts Monday through Friday between 8 am and 4:30 pm.
- With a Retirement Plan Advisor:
- Schedule a virtual or in-person meeting with a WDC Retirement Plan Advisor. Go to wdc457.org then Schedule a Meeting in the bottom left-hand corner.
- Email:
Visit the Edvest website for forms.
If you would like to apply for the Public Service Loan Forgiveness Program, print and complete Sections 1 and 2 of the Public Service Loan Forgiveness Certification and Application. Submit the form along with the Public Service Loan Forgiveness Employer Verification Request to UW-Shared Services, Service Operations. Completed forms may be faxed to (608) 890-2327 or mailed to UW-Shared Services, Service Operations, 660 W. Washington Ave, Suite 201, Madison, WI 53703 (do not email forms).
- – Complete and submit this form to your institution to request W/FMLA-protected leave. If you request a WFMLA leave to care for a domestic partner or a domestic partner’s parent, you must complete this form to certify the domestic partnership for WFMLA purposes.
- – Your health care provider must complete this form to certify your serious health condition if you take a concurrent FMLA and WFMLA leave. If you take a WFMLA leave only, use the WFMLA Certification form (UWS 82a) to certify your own serious health condition.
- – If you take a WFMLA leave only, use this form to certify your own serious health condition.
- – Your family member’s health care provider must complete this form to certify their serious health condition if you take a concurrent FMLA and WFMLA leave. If you take a WFMLA leave only, use the WFMLA Certification form (UWS 83a) to certify your family member’s serious health condition.
- – If you take a WFMLA leave only, use this form to certify your family member’s serious health condition.
- – Complete and submit this form to your institution to certify an exigency was created because a family member is on covered active military duty or has been notified of an impending call or order to active duty to a foreign country or international waters. The family member may be in either the regular or reserve component of the Armed Forces.
- – Complete and submit this form to your institution to request FMLA-protected leave to care for a current military service member, who is a family member or next of kin, who is seriously ill or injured due to military service.
- – Complete and submit this form to your institution to request FMLA-protected leave to care for a veteran, who is a family member or next of kin, who is seriously ill or injured due to military service.
- FMLA Guide for Employees
- FMLA Poster
- WFMLA Poster
Below are common payroll forms. Complete these forms through the MyUW portal or via paper. If completed via paper submit them to your human resources office at your institution.
- Direct Deposit
- Employee Self-Identification and W-4 Withholding Forms
- New Employees (paper forms):
- Current employees (use the MyUW portal):
For additional payroll information review the Payroll web page.
Remember to review and update your beneficiary designations when you have a life event to make sure that your benefits are paid according to your wishes. Benefit plans that have beneficiary designations include life insurance plans, retirement plans and the health savings account.
Updated: 08/27/2020