Updated Employer Verification of Health Insurance Coverage (ET-4814) Form for Local Employers

ETF has updated the Local Employer Verification of Health Insurance Coverage (ET-4814) form. This update means that local employers will no longer collect the forms from employees and survivors that want to continue health insurance coverage after the employee retires or dies. Coverage now continues automatically, and employees and survivors only need to complete the form to cancel coverage.

Local employers should continue to use this form when:

• Your employees retire or pass away. 
  • This will let ETF, your employees, and your employee’s survivors know if you will continue to make employer contributions to retiree and survivor premiums after retirement or death. 
  • You stop contributing to premiums for retirees and survivors. In this case, you must submit the form to ETF two months before your premium contributions end.

For additional information on how and when to use this form, please look for the upcoming Local Employer Verification of Health Insurance Coverage (ET-4814) video in the Employer Training section of the ETF website. The video will detail the updated form, including important events requiring the form.