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Online Services Terms and Conditions of Use Agreement for Members

These terms govern a member's use of ETF online service, enrollment in available ETF insurance benefits, and receipt of available ETF insurance benefits.

24ET-2100cc

Brochure Retiree

2024 Medicare Advantage Evidence of Coverage - Non-deductible

This Evidences of Coverage provides details about Medicare health care coverage from January 1, 2024 - December 31, 2024.

24ET-2100ccd

Brochure Retiree

2024 Medicare Advantage Evidence of Coverage - Deductible

Medicare Advantage, with deductible, Evidence of Coverage for the 2024 plan year.

25ET-2100cc

Brochure Retiree

2025 Medicare Advantage Evidence of Coverage - Non-deductible

This Evidence of Coverage provides details about Medicare health care coverage for the 2025 plan year.

25ET-2100ccd

Brochure Retiree

2025 Medicare Advantage Evidence of Coverage - Deductible

Medicare Advantage, with deductible, Evidence of Coverage for the 2025 plan year.

Mental Health Resources

Mental health is just as important as physical health when it comes to your overall well-being. Learn about mental health resources available through the Group Health Insurance Program and Employee Assistance Programs.

Dependent Information 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

State and Federal Notifications

Program Option

Local Annuitant Health Program (LAHP)
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-4814

Form Active Employee / Retiree / Local Employer

Local Employer Verification of Health Insurance Coverage

Local employers, complete to submit verification for an employee's or local-paid retiree's health insurance coverage.

ET-2421

Form Active Employee / Retiree

Request for Copies of My Medical Information

Use this form to request to inspect or copy medical information maintained about you by ETF.