Cancellation or Termination of Health Coverage FAQs Program Option Local Deductible Health Plan (PO14) & Supplemental Benefits Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits Local Health Plan (PO16) & Supplemental Benefits Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits Local High Deductible Health Plan (PO17) & Supplemental Benefits Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits Local Traditional Health Plan (PO12) & Supplemental Benefits Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits State Employee and Retiree Health Plan & Supplemental Benefits
Medicare Advantage FAQs Program Option Local Deductible Health Plan (PO14) & Supplemental Benefits Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits Local Health Plan (PO16) & Supplemental Benefits Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits Local High Deductible Health Plan (PO17) & Supplemental Benefits Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits Local Traditional Health Plan (PO12) & Supplemental Benefits Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits State Employee and Retiree Health Plan & Supplemental Benefits
25ET-2180 Brochure Active Employee / Retiree / Other Benefit Recipient / Local Employer / State Employer 2025 Uniform Benefits Certificate of Coverage This Certificate of Coverage is your Summary Plan Description and contains the Uniform Benefits offered under the Group Health Insurance Program.
24ET-2180 Brochure Active Employee / Retiree / Other Benefit Recipient / Local Employer / State Employer 2024 Uniform Benefits Certificate of Coverage This Certificate of Coverage is your Summary Plan Description and contains the Uniform Benefits offered under the Group Health Insurance Program.
National Medical Support Notice Program Option Local Deductible Health Plan (PO14) & Supplemental Benefits Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits Local Health Plan (PO16) & Supplemental Benefits Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits Local High Deductible Health Plan (PO17) & Supplemental Benefits Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits Local Traditional Health Plan (PO12) & Supplemental Benefits Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits State Employee and Retiree Health Plan & Supplemental Benefits
ET-4303 Form Active Employee / Local Employer / State Employer Waiver of Part-Time Elected Service Form for elected officials to irrevocably waive further participation in the WRS for current, and any future, service as an elected official that does not exceed 1,044 hours per year.
Summary of Benefits and Coverage A snapshot of a health plan's costs, benefits, covered healthcare services, and other important features. Program Option Local Traditional Health Plan (PO12) & Supplemental Benefits Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits Plan Year 2025
Summary of Benefits and Coverage A snapshot of a health plan's costs, benefits, covered healthcare services, and other important features. Program Option Local High Deductible Health Plan (PO17) & Supplemental Benefits Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits Plan Year 2025
Summary of Benefits and Coverage A snapshot of a health plan's costs, benefits, covered healthcare services, and other important features. Program Option Local Deductible Health Plan (PO14) & Supplemental Benefits Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits Plan Year 2025
Summary of Benefits and Coverage A snapshot of a health plan's costs, benefits, covered healthcare services, and other important features. Plan Year 2025 Program Option Local Annuitant Health Program (LAHP)