Overview
Benefit applications, forms, and resources for each benefit plan can be accessed below.
Submit completed applications to your benefits contact.
Forms & Resources
Forms
Resources
- Health Benefits Decision Guide
- Glossary of Health Coverage and Medical Terms
- Guide to Office Visit Copays
- How to Choose Your Health Insurance Plan
- How to Get Care When You Need It eLearning (ETF)
- Patient Rights and Responsibilities
- Plan Design Options eLearning (ETF)
- Preventive Care Services Covered
- 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
Go to the Uniform & Preventive Dental Insurance web page and Supplemental Dental Insurance web page for information and resources on these programs.
Go to the Vision Insurance web page for information and resources on this program.
Go to the State Group Life Insurance web page for information and resources on this program.
Go to the Individual & Family Life Insurance web page for information and resources on this program.
Go to the Accidental Death & Dismemberment Insurance web page for information and resources on this program.
Go to the Accident Insurance web page for information and resources on this program.
Go to the Income Continuation Insurance web page for information and resources on this program.
Flexible Spending Accounts (FSAs)
Health Savings Accounts (HSAs)
An HSA is available to individuals enrolled in a High Deductible Health Plan (HDHP) through the Universities of Wisconsin; 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
Go to the Wisconsin Retirement System web page for information and resources on this program.
Plan Document
EZ Enrollment Form
Salary Reduction Agreement
Go to the Wisconsin Deferred Compensation (WDC) 457 Program web page for information and resources on this program.
For information and resources on leave benefits including family & medical leave go to the web pages listed below.
Go to the 529 College Savings Plan web page for information and resources on this program.
Go to the Public Service Loan Forgiveness Program web page for information and resources on this program.
Below are common payroll forms. Complete these forms by signing into my.wisconsin.edu or via paper. If a paper form is completed submit it to your human resources office.
- Direct Deposit
- Employee Self-Identification and W-4 Withholding Forms
- New Employees (paper forms):
- Current employees (use the my.wisconsin.edu):
For additional payroll information review the Payroll web page.
Every effort has been made to ensure this information is current and correct. Information on this page does not guarantee enrollment, benefits and/or the ability to make changes to your benefits.