It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF
It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF
It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF
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Group Health Insurance Applications<br />
Madison<br />
Art Fair on the Square<br />
If you want to change health plans or change to family or<br />
single coverage, drop your adult dependent child or enroll<br />
if you previously deferred coverage (if you are an eligible<br />
employee, annuitant or surviving spouse/dependent) for<br />
next year, submit your completed application and retain<br />
one for your records. Copies of the Group Health Insurance<br />
Application/Change Form (<strong>ET</strong>-2301) are also available at<br />
etf.wi.gov.<br />
<strong>Your</strong> application must be submitted electronically (see Pages<br />
76 and 77), handed in, faxed or postmarked by the last day<br />
of the It’s <strong>Your</strong> <strong>Choice</strong> Open Enrollment period (November 2,<br />
2012). Late applications will not be accepted.<br />
<strong>Decision</strong> <strong>Guide</strong> Page 78
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