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This form gives ETF and entities that perform contracted services for ETF permission to release your designated medical information to a person or entity specified by you.

This Evidences of Coverage provides details about Medicare health care coverage from January 1, 2023 - December 31, 2023. 

Medicare Advantage, with deductible, Evidence of Coverage for the 2023 plan year.

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

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

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.

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

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