Employees, enroll in health insurance or change your coverage.
If you would like to complete the form electronically, be sure to first download the form, complete using Acrobat Reader, and save.
Submit the completed form to your employer.
Note: ETF is unable to assist with Adobe Acrobat Reader technical or compatibility issues. If you need assistance, please visit Adobe’s help site at https://helpx.adobe.com/support/reader.html.