State Group Life Insurance

  1. Overview
  2. Publications
  3. Forms

Plan Overview

Description: The plan provides group term life insurance. Coverage, based on your highest Wisconsin Retirement System calendar year earnings, is available up to 5 times your annual income. Spouse/Domestic Partner and Dependent coverage is available.

Premiums

State Group Life Insurance Premiums

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More Information

Administered by

WI Department of Employee Trust Funds (ETF)

Vendor

Securian Financial Group

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

Evidence of Insurability | Submit to Securian Financial Group

Evidence of Insurability Application, ET-2305
If you do not enroll during your initial enrollment period, you may apply for coverage using this form.

Beneficiary Designation | Submit to ETF

Conversion | Submit to Securian Financial Group

Conversion of Group Life Insurance Enrollment, ET-2306

Accelerated Benefit | Contact Securian Financial Group to request the form