Complete a Health Insurance Application/Change For Retirees & COBRA Continuants (ET-2331) form or log in to

  • is available for currently enrolled retirees only.
  • If your family has some members with Medicare and some without Medicare, you will need to complete and submit a paper Health Insurance Application/Change For Retiress & COBRA Continuants (ET-2331) form to change coverage.

Contact ETF with questions.

Local Active Employees and COBRA members

You can complete a Group Health Insurance Application/Change Form (ET-2301) or log in to Contact your payroll/benefits office with any questions.