Income Continuation Insurance (ICI)

  1. Overview
  2. Publications
  3. Forms

Plan Overview

Description: The plan provides up to 75% of gross wages as replacement income if you become disabled. Benefits begin after a selected waiting period (minimum of 30 consecutive calendar days) or use of accumulated sick leave (up to 130 days), whichever is longer. There are two coverage levels: Standard ICI covers earnings up to $64,000; Supplemental ICI covers earnings from $64,001 to $120,000.

Premiums

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Administered by

WI Department of Employee Trust Funds (ETF)

Vendor

Aetna

Send questions to: benefits@ohr.wisc.edu

Forms

Note: Use Adobe Reader to open and complete PDF forms.
MAC Users: Do not use "Preview", a PDF reader.

Application | Submit to your Payroll & Benefits Office

Income Continuation Insurance Application, ET-2307

Evidence of Insurability | Submit to ETF

Evidence of Insurability, ET-2308
If you do not enroll for ICI coverage when you are first eligible, you can enroll only by completing an Evidence of Insurability application.