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Wisconsin Department of Employee Trust Funds fax number

(608) 267-4549

Health Insurance

Used for: Health Insurance Application/Change submission (ET-2301) for enrollment or changes to the State Group Health Insurance Program; open enrollment, new hire, life events.

Fax destination details

Department
Health Insurance
Purpose
Health Insurance Application/Change submission (ET-2301) for enrollment or changes to the State Group Health Insurance Program; open enrollment, new hire, life events.
Form
ET-2301 — Health Insurance Application/Change Form
Address
P.O. Box 7931, Madison, WI 53707-7931
Voice phone
1-877-533-5020

Before you send

  • Confirm that this exact department handles your document or request.
  • Check the organization website or call its main line for the current fax number.
  • Include a cover sheet and any case, member, claim, or form reference required.
  • Keep the delivery confirmation with your submission records.

Complete subscriber information, select the reason for enrollment/change, and submit to your employer's benefits office or ETF. Mail to ETF: P.O. Box 7931, Madison, WI 53707-7931; fax to 608-267-4549. See ETF's Health Insurance Application/Change Form for details.

Review official form instructions

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