State of Wisconsin Group Health Insurance Program
Forms + Resources
Forms
- Estimate your costs,:determination of benefits worksheet (PDF)
- Authorization for Disclosure of Protected Health Information
- Health plan transition form (PDF)
- Member claim form (PDF)
- At-Home COVID test claim form (PDF) (for at-home COVID-19 test)
2024
UW Health network
Central network
West network
2023
UW Health network
Central network
West network
ETF Resources
Benefits Available to me Search
Essential information and resources
- View the most recent issue of the Member newsletter.
- View Your Rights and Protections Against Surprise Medical Bills