ET-6303 Form Other Benefit Recipient Notice of Death for Spouse or Dependent Child Notify the third party administrator of the group life insurance program of a member's spouse or dependent death.
COBRA / Continuation 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 Plan Year 2024
COBRA/Continuation of Health Coverage FAQs Program Option State Employee and Retiree Health Plan & Supplemental Benefits Plan Year 2024
Medicare Advantage FAQs Program Option State Employee and Retiree Health Plan & Supplemental Benefits Plan Year 2024
Cancellation or Termination of Health Coverage FAQs Program Option State Employee and Retiree Health Plan & Supplemental Benefits Plan Year 2024
23ET-2180 Brochure Active Employee / Retiree / Other Benefit Recipient / Local Employer / State Employer 2023 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.
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 Plan Year 2024
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
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 2024