Health Insurance Employer Forms

Use the following forms to administer the Group Health Insurance program. If you are not finding what you need, go to the Employer Forms, Brochures and Publications page to search through all publications.

Use the keyword filter to search by ET number or form name.

Filter table by typing keywords

ET-Number	Form Name
ET-7406	Authorization to Disclose Non-Medical Individual Personal Information
ET-7414	Authorization to Disclose Medical Information
ET-7117	Benefit/Health Fair Request Form
ET-2311	Continuation - Conversion Notice
ET-4814	Local Employer Verification of Health Insurance Coverage
ET-1152	Existing Employer Option Selection Resolution WPE Health Insurance
ET-1169	Existing Employer Update Resolution WPE Group Health Insurance Program
ET-2301	Group Health Insurance Application/Change Form
ET-2350	Health Insurance Election for Military Service Personnel - State
ET-1728	Health Plan and Vendor Contacts
ET-8108	Nondiscrimination and Language Access
ET-4305	Sick Leave Escrow Application
ET-8937	Online Network for Health Plans Security Agreement