Primary Care Provider (PCP) Submission Form

For 2018, the Department of Employee Trust Funds (ETF) requires Wisconsin Group Health Insurance Program members to select a primary care provider, or PCP. Please complete the form below to select your primary care provider. You must submit a primary care provider selection for you and each family member. You must click the "submit" button to record your choices.

For out-of-state Access and IYC Medicare Plus providers: Please provide name of your PCP even if you don’t have a corresponding Provider ID.