ET-1303 Form Local Employer / State Employer Resolution for Inclusion Under Group Life Insurance Resolution for employers to join the group life insurance program.
You Plan to Retire Soon (Active Employees Only) Experiencing this life event may allow you to make changes to your accident plan or health, dental, vision, or long-term care insurance. 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-2155 Form State Employer Group Health Insurance Program Continuation Application For State Employees With 20 Years of WRS-Creditable Service. Employers, complete your sections and then give the form to the employee.