University of Wisconsin–Milwaukee

Benefits Program Enrollment or Change

30 day enrollment or change deadline

Now that you have reviewed your plan options you are ready to enroll or make changes to your current enrollment with a qualifying life event. Below you will find links to the enrollment paperwork grouped by benefit type. Once you have completed the application(s), please bring them to Engelmann 125 during business hours or fax to 414-229-4102 to submit for enrollment or changes.

• All State Group Health Insurances:
  • http://www.bussvc.wisc.edu/ecbs/et2301.pdf

• State Group Life: http://uwservice.wisc.edu/docs/forms/et2304.pdf
  • Beneficiary Designation: http://uwservice.wisc.edu/docs/forms/et2320.pdf
• Accidental Death & Dismemberment: http://www.wisconsin.edu/hr/benefits/ins/uws1245.pdf
  • Beneficiary Designation: http://www.wisconsin.edu/hr/benefits/ins/uws1247.pdf
• Individual & Family: http://www.wisconsin.edu/hr/benefits/ins/lifapp.pdf
  • Beneficiary Designation: http://www.wisconsin.edu/hr/benefits/ins/uws1305.pdf
• UW Employees Inc: http://www.wisconsin.edu/hr/benefits/ins/uwe-app.pdf
  • Beneficiary Designation: http://www.wisconsin.edu/hr/benefits/ins/uwe-bene.pdf
• University Insurance Association: Automatic enrollment for those eligible
  • Beneficiary Designation: http://www.wisconsin.edu/hr/benefits/ins/luia_bene.pdf

• Dental Wisconsin: http://www.wisconsin.edu/hr/benefits/ins/uws64.pdf
• EPIC Benefits+: http://www.wisconsin.edu/hr/benefits/ins/benefits+app.pdf
  • Beneficiary Designation: http://www.epiclife.com/pdfs/beneficiary.pdf
• Vision Service Plan (VSP): http://www.wisconsin.edu/hr/benefits/ins/uws66.pdf

• Tax Sheltered Annuity (TSA)/403b:
  • Contact Vendor to Create a UW System Account: http://www.wisconsin.edu/hr/benefits/retsav/tsaenroll.htm
  • Then Submit a Salary Reduction Agreement: http://uwservice.wisc.edu/docs/forms/sraform.pdf
• Wisconsin Deferred Compensation Program (WDC)/457:
  • Enrollment Application: http://www.fascore.com/PDF/wisconsin/WDC_EZ_Enroll.pdf
• Wisconsin Retirement System (WRS):
  • Variable Fund Participation: http://etf.wi.gov/publications/et2356.pdf
  • Optional Additional Contributions: http://www.bussvc.wisc.edu/ecbs/uw1069-voluntary-wrs-contributions.pdf
• Employee Reimbursement Accounts (ERA):
  • Initial Enrollment: http://uwservice.wisc.edu/docs/forms/era-enrollment.pdf
  • Changes to Current Enrollment: http://uwservice.wisc.edu/docs/forms/era-status-change.pdf

• Income Continuation Insurance (ICI):
  • http://uwservice.wisc.edu/docs/forms/ici-application.pdf