{"id":69,"date":"2014-07-29T14:57:36","date_gmt":"2014-07-29T19:57:36","guid":{"rendered":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/?page_id=69"},"modified":"2026-01-05T13:08:46","modified_gmt":"2026-01-05T19:08:46","slug":"formspubs","status":"publish","type":"page","link":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/formspubs\/","title":{"rendered":"Forms &amp; Resources"},"content":{"rendered":"\n\t\t\t\t\t<div id=\"cfct-build-69\" class=\"cfct-build grid\">\n\t\t\t\t\t\t<div class=\"row\"><div class=\"col-md-3 cfct-block\">\n\t\t\t<div class=\"cfct-module cfct-supplemental\">\n\t\t\t\t    <div class=\"cfct-mod-content hidden-print\">\n    <nav class=\"widget widget_meta\" >\n\n        <div class=\"menu-cfct-module-f920a65573b2f6ffa5c17a08d7d1bd9f-container\"><ul id = \"menu-full-benefits-menu\" class = \"menu nav\"><li id=\"menu-item-22783\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-22783\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/general-employee-info\/\">General Employee Information<\/a><\/li>\n<li id=\"menu-item-7385\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-7385\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/health\/\">Health Insurance<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-7392\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7392\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/health\/health-plan-design\/\">Health Plan Design<\/a><\/li>\n\t<li id=\"menu-item-7391\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7391\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/health\/hdhp\/\">HDHP Plan Design<\/a><\/li>\n\t<li id=\"menu-item-7388\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7388\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/health\/access-plan\/\">Access Health Plan Design<\/a><\/li>\n\t<li id=\"menu-item-7387\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7387\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/health\/access-hdhp\/\">Access HDHP Plan Design<\/a><\/li>\n\t<li id=\"menu-item-12975\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-12975\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/health\/pharmacy-benefits\/\">Pharmacy Benefits<\/a><\/li>\n\t<li id=\"menu-item-11780\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-11780\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/opt-out\/\">Opt-Out Incentive<\/a><\/li>\n\t<li id=\"menu-item-7393\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7393\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/health\/select-a-plan\/\">How To Choose Your Health Insurance Plan<\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-7396\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-7396\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/dental-vision\/\">Dental &amp; Vision Insurance<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-10563\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-10563\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/health\/uniform-dental\/\">Uniform &amp; Preventive Dental Insurance<\/a><\/li>\n\t<li id=\"menu-item-10566\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-10566\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/dental-vision\/suppdental\/\">Supplemental Dental Insurance<\/a><\/li>\n\t<li id=\"menu-item-7399\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7399\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/dental-vision\/vision\/\">Vision Insurance<\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-8103\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-8103\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/life\/\">Life Insurance<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-7406\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7406\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/life\/sgl\/\">State Group Life Insurance<\/a><\/li>\n\t<li id=\"menu-item-7403\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7403\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/life\/if\/\">Individual &amp; Family Life Insurance<\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-15934\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-15934\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/accident\/\">AD&amp;D and Accident Insurance<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-7402\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7402\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/accident\/add\/\">Accidental Death &amp; Dismemberment Insurance<\/a><\/li>\n\t<li id=\"menu-item-15065\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-15065\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/accident\/accident\/\">Accident Insurance<\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-13604\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-13604\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/disability\/\">Disability and Income Continuation<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-13609\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-13609\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/disability\/ici\/\">Income Continuation Insurance<\/a><\/li>\n\t<li id=\"menu-item-13608\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-13608\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/disability\/disret\/\">Disability Retirement Program<\/a><\/li>\n\t<li id=\"menu-item-13607\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-13607\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/disability\/duty\/\">Duty Disability<\/a><\/li>\n\t<li id=\"menu-item-13606\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-13606\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/disability\/workcomp\/\">Worker\u2019s Compensation<\/a><\/li>\n\t<li id=\"menu-item-13605\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-13605\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/disability\/ss\/\">Social Security Disability<\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-8100\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-8100\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/spending-savings-accts\/\">Spending &amp; Savings Accounts<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-7408\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7408\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/spending-savings-accts\/fsa\/\">Flexible Spending Accounts<\/a><\/li>\n\t<li id=\"menu-item-8102\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-8102\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/spending-savings-accts\/hsa\/\">Health Savings Account<\/a><\/li>\n\t<li id=\"menu-item-8101\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-8101\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/spending-savings-accts\/parking-transit\/\">Parking &amp; Transit Accounts<\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-7412\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-7412\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/ret\/\">Retirement Plans<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-7411\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7411\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/ret\/wrs\/\">Wisconsin Retirement System<\/a><\/li>\n\t<li id=\"menu-item-7413\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7413\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/ret\/srp\/\">UW 403(b) Supplemental Retirement Program<\/a><\/li>\n\t<li id=\"menu-item-7410\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7410\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/ret\/wdc\/\">Wisconsin Deferred Compensation 457 Program<\/a><\/li>\n\t<li id=\"menu-item-11481\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-11481\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/sick-leave-credit-conversion-program\/\">Sick Leave Credit Conversion Program<\/a><\/li>\n\t<li id=\"menu-item-7414\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7414\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/ret\/ssm\/\">Social Security and Medicare<\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-7416\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-7416\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/\">Leave Benefits<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-7423\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7423\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/vacation\/\">Vacation<\/a><\/li>\n\t<li id=\"menu-item-7420\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7420\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/ph\/\">Personal Holiday<\/a><\/li>\n\t<li id=\"menu-item-7417\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7417\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/holidays\/\">Legal Holidays<\/a><\/li>\n\t<li id=\"menu-item-7421\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7421\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/sick\/\">Sick Leave<\/a><\/li>\n\t<li id=\"menu-item-27331\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-27331\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/paid-parental-leave\/\">Paid Parental Leave<\/a><\/li>\n\t<li id=\"menu-item-7427\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7427\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/fmla\/\">Family &amp; Medical Leave<\/a><\/li>\n\t<li id=\"menu-item-7419\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7419\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/misc\/\">Miscellaneous Leave Provisions<\/a><\/li>\n\t<li id=\"menu-item-7424\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7424\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/meddonation\/\">Bone Marrow and Human Organ Donation<\/a><\/li>\n\t<li id=\"menu-item-7425\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7425\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/catastrophic\/\">Catastrophic Leave<\/a><\/li>\n\t<li id=\"menu-item-7418\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7418\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/military\/\">Military Leave<\/a><\/li>\n\t<li id=\"menu-item-9585\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-9585\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/reporting\/\">Leave Reporting<\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-7893\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-7893\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/other-benefits\/\">Other Benefits<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-12441\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-12441\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/other-benefits\/529-college-savings-plan\/\">529 College Savings Plan<\/a><\/li>\n\t<li id=\"menu-item-12440\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-12440\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/other-benefits\/educationalreimbursement\/\">Career-Related Educational Reimbursement<\/a><\/li>\n\t<li id=\"menu-item-12439\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-12439\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/other-benefits\/lifestyle\/\">Lifestyle Benefits Program<\/a><\/li>\n\t<li id=\"menu-item-12438\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-12438\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/other-benefits\/long-term-care-insurance\/\">Long-Term Care Insurance<\/a><\/li>\n\t<li id=\"menu-item-22096\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-22096\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/other-benefits\/public-service-loan-forgiveness-program\/\">Public Service Loan Forgiveness Program<\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-7598\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-7598\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/life-events\/\">Life Events<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-13782\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-13782\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/life-events\/empcha\/\">Employment Changes<\/a><\/li>\n\t<li id=\"menu-item-13783\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-13783\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/life-events\/famchng\/\">Family Changes<\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-7428\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7428\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/premiums\/\">Benefits Premiums<\/a><\/li>\n<li id=\"menu-item-27142\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-27142\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/formspubs\/\">Forms &amp; Resources<\/a><\/li>\n<li id=\"menu-item-7429\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-7429\"><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/contact\/\">Benefits Contacts<\/a><\/li>\n<\/ul><\/div>    <\/nav>\n<\/div>\n\n\t\t\t<\/div><\/div><div class=\"col-md-9 cfct-block\">\n\t\t\t<div class=\"cfct-module uwsa-rich-text\">\n\t\t\t\t<div class=\"cfct-mod-content copy\"><div id=\"toc\" class=\"uwsa-toc callout hidden-print\"><\/div><style>@media (min-width: 768px) {#toc { max-width: 40%} <\/style><script>jQuery(document).ready(function() {\n \t\t\t\t\tgenerateTOC(\"Forms &amp; Resources\", \"\", \"div.entry-content\" ,2 ,\"true\", \"toc\");\n \t\t\t\t\t });<\/script>\n<h2>Overview<\/h2>\n<p>Benefit applications, forms, and resources for each benefit plan can be accessed below.<\/p>\n<p>Submit completed applications to your <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/contact\/\" target=\"_blank\" rel=\"noopener\">benefits contact<\/a>.<\/p>\n<h2>Forms &amp; Resources<\/h2>\n<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"cfct-module uwsa-tabs-accordions\">\n\t\t\t\t    <div class=\"bs-accordion \">\n            <div class=\"accordion-all-buttons\">\n          <a href=\"#\" class=\"accordions-showall btn btn-primary btn-xs\" role=\"button\" data-panel=\"r4mfc\"><span class=\"uw-resize-full\">Open All<\/span><\/a>\n        <\/div>\n        <div id=\"r4mfc\" class=\"panel-group\">\n        \n            <div class=\"panel panel-default \" id=\"panel_state-group-health-insurance\">\n    <div class=\"panel-heading\" id=\"heading_state-group-health-insurance\">\n        <h4 class=\"panel-title\"><button href=\"#state-group-health-insurance\" data-toggle=\"collapse\" class=\"collapsed panel-link\" aria-expanded=\"false\" aria-controls=\"state-group-health-insurance\">State Group Health Insurance<\/button><\/h4>    <\/div>\n    <div id=\"state-group-health-insurance\" class=\"panel-collapse collapse\"  role=\"tabpanel\" aria-labelledby=\"heading_state-group-health-insurance\" role=\"region\">\n        <div class=\"panel-body copy\">            \n            \n        <ul><li><span class=\"doc-icon\"><a class=\"doc-type pdf\" href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/download\/Health-Insurance-Application-Change-Form1.pdf\" target=\"_blank\">2025 Health Insurance Application\/Change Form (ET-2301)<span class=\"sr-only\"> pdf<\/span><\/a><\/span>\r\n<\/li><li><a href=\"https:\/\/etf.wi.gov\/publications\/et2301\/download?inline=\" target=\"_blank\" rel=\"noopener\">2026 Health Insurance Application\/Change Form (ET-2301)<\/a><\/li><\/ul><p>Go to the <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/health\/\">State Group Health Insurance web page<\/a> for information and resources on this program.<\/p>                <\/div>\n    <\/div>\n<\/div>\n            <div class=\"panel panel-default \" id=\"panel_dental-insurance-uniform-preventive-and-supplemental\">\n    <div class=\"panel-heading\" id=\"heading_dental-insurance-uniform-preventive-and-supplemental\">\n        <h4 class=\"panel-title\"><button href=\"#dental-insurance-uniform-preventive-and-supplemental\" data-toggle=\"collapse\" class=\"collapsed panel-link\" aria-expanded=\"false\" aria-controls=\"dental-insurance-uniform-preventive-and-supplemental\">Dental Insurance: Uniform, Preventive and Supplemental<\/button><\/h4>    <\/div>\n    <div id=\"dental-insurance-uniform-preventive-and-supplemental\" class=\"panel-collapse collapse\"  role=\"tabpanel\" aria-labelledby=\"heading_dental-insurance-uniform-preventive-and-supplemental\" role=\"region\">\n        <div class=\"panel-body copy\">            \n            \n        <ul><li><a href=\"https:\/\/etf.wi.gov\/publications\/et-2339\/download?inline=\" target=\"_blank\" rel=\"noopener\">Supplemental Insurance (dental, vision, accident) Application\/Change Form (ET-2339)<\/a><\/li><\/ul><p>Go to the <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/dental-vision\/vision\/\">Uniform &amp; Preventive Dental Insurance web page<\/a> and <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/dental-vision\/suppdental\/\">Supplemental Dental Insurance web page<\/a> for information and resources on these programs.<\/p>                <\/div>\n    <\/div>\n<\/div>\n            <div class=\"panel panel-default \" id=\"panel_vision-insurance\">\n    <div class=\"panel-heading\" id=\"heading_vision-insurance\">\n        <h4 class=\"panel-title\"><button href=\"#vision-insurance\" data-toggle=\"collapse\" class=\"collapsed panel-link\" aria-expanded=\"false\" aria-controls=\"vision-insurance\">Vision Insurance<\/button><\/h4>    <\/div>\n    <div id=\"vision-insurance\" class=\"panel-collapse collapse\"  role=\"tabpanel\" aria-labelledby=\"heading_vision-insurance\" role=\"region\">\n        <div class=\"panel-body copy\">            \n            \n        <ul><li><a href=\"https:\/\/etf.wi.gov\/publications\/et-2339\/download?inline=\" target=\"_blank\" rel=\"noopener\">Supplemental Insurance (dental, vision, accident) Application\/Change Form (ET-2339)<\/a><\/li><\/ul><p>Go to the <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/dental-vision\/vision\/\">Vision Insurance web page<\/a> for information and resources on this program.<\/p>                <\/div>\n    <\/div>\n<\/div>\n            <div class=\"panel panel-default \" id=\"panel_state-group-life-insurance\">\n    <div class=\"panel-heading\" id=\"heading_state-group-life-insurance\">\n        <h4 class=\"panel-title\"><button href=\"#state-group-life-insurance\" data-toggle=\"collapse\" class=\"collapsed panel-link\" aria-expanded=\"false\" aria-controls=\"state-group-life-insurance\">State Group Life Insurance<\/button><\/h4>    <\/div>\n    <div id=\"state-group-life-insurance\" class=\"panel-collapse collapse\"  role=\"tabpanel\" aria-labelledby=\"heading_state-group-life-insurance\" role=\"region\">\n        <div class=\"panel-body copy\">            \n            \n        <ul><li><a href=\"https:\/\/etf.wi.gov\/publications\/et2304\/download?inline=\" target=\"_blank\" rel=\"noopener\">State Group Life Insurance Application\/Cancellation\/Refusal (ET-2304)<\/a><\/li><\/ul><p>Go to the <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/life\/sgl\/\">State Group Life Insurance web page<\/a> for information and resources on this program.<\/p>                <\/div>\n    <\/div>\n<\/div>\n            <div class=\"panel panel-default \" id=\"panel_individual-family-life-insurance\">\n    <div class=\"panel-heading\" id=\"heading_individual-family-life-insurance\">\n        <h4 class=\"panel-title\"><button href=\"#individual-family-life-insurance\" data-toggle=\"collapse\" class=\"collapsed panel-link\" aria-expanded=\"false\" aria-controls=\"individual-family-life-insurance\">Individual &amp; Family Life Insurance<\/button><\/h4>    <\/div>\n    <div id=\"individual-family-life-insurance\" class=\"panel-collapse collapse\"  role=\"tabpanel\" aria-labelledby=\"heading_individual-family-life-insurance\" role=\"region\">\n        <div class=\"panel-body copy\">            \n            \n        <ul><li><span class=\"doc-icon\"><a class=\"doc-type pdf\" href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/download\/life\/if\/app.pdf\" target=\"_blank\">Individual & Family Life Insurance Application<span class=\"sr-only\"> pdf<\/span><\/a><\/span>\r\n<\/li><\/ul><p>Go to the <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/life\/if\/\">Individual &amp; Family Life Insurance web page<\/a> for information and resources on this program.<\/p>                <\/div>\n    <\/div>\n<\/div>\n            <div class=\"panel panel-default \" id=\"panel_accidental-death-dismemberment-insurance\">\n    <div class=\"panel-heading\" id=\"heading_accidental-death-dismemberment-insurance\">\n        <h4 class=\"panel-title\"><button href=\"#accidental-death-dismemberment-insurance\" data-toggle=\"collapse\" class=\"collapsed panel-link\" aria-expanded=\"false\" aria-controls=\"accidental-death-dismemberment-insurance\">Accidental Death &amp; Dismemberment Insurance<\/button><\/h4>    <\/div>\n    <div id=\"accidental-death-dismemberment-insurance\" class=\"panel-collapse collapse\"  role=\"tabpanel\" aria-labelledby=\"heading_accidental-death-dismemberment-insurance\" role=\"region\">\n        <div class=\"panel-body copy\">            \n            \n        <ul><li><span class=\"doc-icon\"><a class=\"doc-type pdf\" href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/download\/life\/add\/app.pdf\" target=\"_blank\">Accidental Death & Dismemberment Insurance Application<span class=\"sr-only\"> pdf<\/span><\/a><\/span>\r\n<\/li><\/ul><p>Go to the <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/accident\/add\/\">Accidental Death &amp; Dismemberment Insurance web page<\/a> for information and resources on this program.<\/p>                <\/div>\n    <\/div>\n<\/div>\n            <div class=\"panel panel-default \" id=\"panel_accident-insurance\">\n    <div class=\"panel-heading\" id=\"heading_accident-insurance\">\n        <h4 class=\"panel-title\"><button href=\"#accident-insurance\" data-toggle=\"collapse\" class=\"collapsed panel-link\" aria-expanded=\"false\" aria-controls=\"accident-insurance\">Accident Insurance<\/button><\/h4>    <\/div>\n    <div id=\"accident-insurance\" class=\"panel-collapse collapse\"  role=\"tabpanel\" aria-labelledby=\"heading_accident-insurance\" role=\"region\">\n        <div class=\"panel-body copy\">            \n            \n        <ul><li><a href=\"https:\/\/etf.wi.gov\/publications\/et-2339\/download?inline=\" target=\"_blank\" rel=\"noopener\">Supplemental Insurance (dental, vision, accident) Application\/Change Form (ET-2339)<\/a><\/li><\/ul><p>Go to the <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/accident\/accident\/\">Accident Insurance web page<\/a> for information and resources on this program.<\/p>                <\/div>\n    <\/div>\n<\/div>\n            <div class=\"panel panel-default \" id=\"panel_income-continuation-insurance\">\n    <div class=\"panel-heading\" id=\"heading_income-continuation-insurance\">\n        <h4 class=\"panel-title\"><button href=\"#income-continuation-insurance\" data-toggle=\"collapse\" class=\"collapsed panel-link\" aria-expanded=\"false\" aria-controls=\"income-continuation-insurance\">Income Continuation Insurance<\/button><\/h4>    <\/div>\n    <div id=\"income-continuation-insurance\" class=\"panel-collapse collapse\"  role=\"tabpanel\" aria-labelledby=\"heading_income-continuation-insurance\" role=\"region\">\n        <div class=\"panel-body copy\">            \n            \n        <ul><li><a href=\"http:\/\/etf.wi.gov\/publications\/et2307.pdf\" target=\"_blank\" rel=\"noopener\">Income Continuation Insurance Application (ET-2307)<\/a><\/li><\/ul><p>Go to the <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/disability\/ici\/\">Income Continuation Insurance web page<\/a> for information and resources on this program.<\/p>                <\/div>\n    <\/div>\n<\/div>\n            <div class=\"panel panel-default \" id=\"panel_spending-and-savings-accounts\">\n    <div class=\"panel-heading\" id=\"heading_spending-and-savings-accounts\">\n        <h4 class=\"panel-title\"><button href=\"#spending-and-savings-accounts\" data-toggle=\"collapse\" class=\"collapsed panel-link\" aria-expanded=\"false\" aria-controls=\"spending-and-savings-accounts\">Spending and Savings Accounts<\/button><\/h4>    <\/div>\n    <div id=\"spending-and-savings-accounts\" class=\"panel-collapse collapse\"  role=\"tabpanel\" aria-labelledby=\"heading_spending-and-savings-accounts\" role=\"region\">\n        <div class=\"panel-body copy\">            \n            \n        <p>Go to the\u00a0<a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/spending-savings-accts\/\">Spending &amp; Savings Accounts web page<\/a> for information and resources on the below accounts.<\/p><ul><li>Flexible Spending Accounts (FSAs)<\/li><li>Health Savings Account (HSA)<\/li><li>Parking &amp; Transit Accounts<\/li><\/ul>                <\/div>\n    <\/div>\n<\/div>\n            <div class=\"panel panel-default \" id=\"panel_wisconsin-retirement-system-wrs\">\n    <div class=\"panel-heading\" id=\"heading_wisconsin-retirement-system-wrs\">\n        <h4 class=\"panel-title\"><button href=\"#wisconsin-retirement-system-wrs\" data-toggle=\"collapse\" class=\"collapsed panel-link\" aria-expanded=\"false\" aria-controls=\"wisconsin-retirement-system-wrs\">Wisconsin Retirement System (WRS)<\/button><\/h4>    <\/div>\n    <div id=\"wisconsin-retirement-system-wrs\" class=\"panel-collapse collapse\"  role=\"tabpanel\" aria-labelledby=\"heading_wisconsin-retirement-system-wrs\" role=\"region\">\n        <div class=\"panel-body copy\">            \n            \n        <p>Go to the <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/ret\/wrs\/\">Wisconsin Retirement System web page<\/a> for information and resources on this program.<\/p>                <\/div>\n    <\/div>\n<\/div>\n            <div class=\"panel panel-default \" id=\"panel_uw-403b-supplemental-retirement-program-srp\">\n    <div class=\"panel-heading\" id=\"heading_uw-403b-supplemental-retirement-program-srp\">\n        <h4 class=\"panel-title\"><button href=\"#uw-403b-supplemental-retirement-program-srp\" data-toggle=\"collapse\" class=\"collapsed panel-link\" aria-expanded=\"false\" aria-controls=\"uw-403b-supplemental-retirement-program-srp\">UW 403(b) Supplemental Retirement Program (SRP)<\/button><\/h4>    <\/div>\n    <div id=\"uw-403b-supplemental-retirement-program-srp\" class=\"panel-collapse collapse\"  role=\"tabpanel\" aria-labelledby=\"heading_uw-403b-supplemental-retirement-program-srp\" role=\"region\">\n        <div class=\"panel-body copy\">            \n            \n        <p>Go to the <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/ret\/srp\/\" target=\"_blank\" rel=\"noopener\">UW 403(b) Supplemental Retirement Program (SRP) web page<\/a> for information and resources on this program.<\/p>                <\/div>\n    <\/div>\n<\/div>\n            <div class=\"panel panel-default \" id=\"panel_wisconsin-deferred-compensation-wdc-457-program\">\n    <div class=\"panel-heading\" id=\"heading_wisconsin-deferred-compensation-wdc-457-program\">\n        <h4 class=\"panel-title\"><button href=\"#wisconsin-deferred-compensation-wdc-457-program\" data-toggle=\"collapse\" class=\"collapsed panel-link\" aria-expanded=\"false\" aria-controls=\"wisconsin-deferred-compensation-wdc-457-program\">Wisconsin Deferred Compensation (WDC) 457 Program <\/button><\/h4>    <\/div>\n    <div id=\"wisconsin-deferred-compensation-wdc-457-program\" class=\"panel-collapse collapse\"  role=\"tabpanel\" aria-labelledby=\"heading_wisconsin-deferred-compensation-wdc-457-program\" role=\"region\">\n        <div class=\"panel-body copy\">            \n            \n        <p>Go to the <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/ret\/wdc\/\">Wisconsin Deferred Compensation (WDC) 457 Program web page<\/a> for information and resources on this program.<\/p>                <\/div>\n    <\/div>\n<\/div>\n            <div class=\"panel panel-default \" id=\"panel_leave-benefits-includes-family-medical-leave\">\n    <div class=\"panel-heading\" id=\"heading_leave-benefits-includes-family-medical-leave\">\n        <h4 class=\"panel-title\"><button href=\"#leave-benefits-includes-family-medical-leave\" data-toggle=\"collapse\" class=\"collapsed panel-link\" aria-expanded=\"false\" aria-controls=\"leave-benefits-includes-family-medical-leave\">Leave Benefits (includes Family &amp; Medical Leave)<\/button><\/h4>    <\/div>\n    <div id=\"leave-benefits-includes-family-medical-leave\" class=\"panel-collapse collapse\"  role=\"tabpanel\" aria-labelledby=\"heading_leave-benefits-includes-family-medical-leave\" role=\"region\">\n        <div class=\"panel-body copy\">            \n            \n        <p>For information and resources on leave benefits including family &amp; medical leave go to the web pages listed below.<\/p><ul><li><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/paid-parental-leave\/\">Paid Parental Leave web page<\/a><\/li><li><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/fmla\/\">Family &amp; Medical Leave web page<\/a><\/li><li><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/meddonation\/\">Bone Marrow and Human Organ Donation web page<\/a><\/li><li><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/catastrophic\/\">Catastrophic Leave web page<\/a><\/li><li><a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/leave\/military\/\">Military Leave web page<\/a><\/li><\/ul>                <\/div>\n    <\/div>\n<\/div>\n            <div class=\"panel panel-default \" id=\"panel_529-college-savings-plan\">\n    <div class=\"panel-heading\" id=\"heading_529-college-savings-plan\">\n        <h4 class=\"panel-title\"><button href=\"#529-college-savings-plan\" data-toggle=\"collapse\" class=\"collapsed panel-link\" aria-expanded=\"false\" aria-controls=\"529-college-savings-plan\">529 College Savings Plan<\/button><\/h4>    <\/div>\n    <div id=\"529-college-savings-plan\" class=\"panel-collapse collapse\"  role=\"tabpanel\" aria-labelledby=\"heading_529-college-savings-plan\" role=\"region\">\n        <div class=\"panel-body copy\">            \n            \n        <p>Go to the <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/other-benefits\/529-college-savings-plan\/\" rel=\"noopener\">529 College Savings Plan web page<\/a> for information and resources on this program.<\/p>                <\/div>\n    <\/div>\n<\/div>\n            <div class=\"panel panel-default \" id=\"panel_public-service-loan-forgiveness-program\">\n    <div class=\"panel-heading\" id=\"heading_public-service-loan-forgiveness-program\">\n        <h4 class=\"panel-title\"><button href=\"#public-service-loan-forgiveness-program\" data-toggle=\"collapse\" class=\"collapsed panel-link\" aria-expanded=\"false\" aria-controls=\"public-service-loan-forgiveness-program\">Public Service Loan Forgiveness Program<\/button><\/h4>    <\/div>\n    <div id=\"public-service-loan-forgiveness-program\" class=\"panel-collapse collapse\"  role=\"tabpanel\" aria-labelledby=\"heading_public-service-loan-forgiveness-program\" role=\"region\">\n        <div class=\"panel-body copy\">            \n            \n        <p>Go to the <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/other-benefits\/public-service-loan-forgiveness-program\/\">Public Service Loan Forgiveness Program web page<\/a> for information and resources on this program.<\/p>                <\/div>\n    <\/div>\n<\/div>\n            <div class=\"panel panel-default \" id=\"panel_payroll-forms\">\n    <div class=\"panel-heading\" id=\"heading_payroll-forms\">\n        <h4 class=\"panel-title\"><button href=\"#payroll-forms\" data-toggle=\"collapse\" class=\"collapsed panel-link\" aria-expanded=\"false\" aria-controls=\"payroll-forms\">Payroll Forms<\/button><\/h4>    <\/div>\n    <div id=\"payroll-forms\" class=\"panel-collapse collapse\"  role=\"tabpanel\" aria-labelledby=\"heading_payroll-forms\" role=\"region\">\n        <div class=\"panel-body copy\">            \n            \n        <p>Go to the <a href=\"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/general-employee-info\/payroll\/\">Payroll web page<\/a> for information and resources on payroll.<\/p>                <\/div>\n    <\/div>\n<\/div>\n            \n    <\/div>\n<\/div>\n\n\n\n\t\t\t<\/div>\n\t\t\t<div class=\"cfct-module uwsa-rich-text\">\n\t\t\t\t<div class=\"cfct-mod-content copy\"><p><em>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. <\/em><\/p>\n<\/div>\n\t\t\t<\/div><\/div><\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":20,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-69","page","type-page","status-publish","hentry","cfct-can-haz-build"],"_links":{"self":[{"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/pages\/69","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/users\/20"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/comments?post=69"}],"version-history":[{"count":40,"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/pages\/69\/revisions"}],"predecessor-version":[{"id":29656,"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/pages\/69\/revisions\/29656"}],"wp:attachment":[{"href":"https:\/\/www.wisconsin.edu\/ohrwd\/benefits\/wp-json\/wp\/v2\/media?parent=69"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}