ET-2385
Form Active Employee / Local Employer / State Employer

Health Savings Account (HSA) Enrollment

For UWs use only, as a paper alternative for a member who cannot complete their HSA enrollment online.

Health Insurance for Retirees with Medicare

Enrolled in Medicare? Learn about the key differences between our Medicare-coordinated plan design options, costs for medical services, available health plans and monthly premium amounts

Plan Year
  • 2025
Program Option
  • Local Traditional Health Plan (PO12) & Supplemental Benefits

Health Insurance for Retirees with Medicare

Enrolled in Medicare? Learn about the key differences between our Medicare-coordinated plan design options, costs for medical services, available health plans and monthly premium amounts

Plan Year
  • 2025
Program Option
  • Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits

Health Insurance for Retirees with Medicare

Enrolled in Medicare? Learn about the key differences between our Medicare-coordinated plan design options, costs for medical services, available health plans and monthly premium amounts

Plan Year
  • 2025
Program Option
  • Local High Deductible Health Plan (PO17) & Supplemental Benefits

Health Insurance for Retirees with Medicare

Enrolled in Medicare? Learn about the key differences between our Medicare-coordinated plan design options, costs for medical services, available health plans and monthly premium amounts

Plan Year
  • 2025
Program Option
  • Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits

Health Insurance for Retirees with Medicare

Learn about the key differences between your plan design options, costs for medical services, available health plans and monthly premium amounts

Plan Year
  • 2025
Program Option
  • Local Health Plan (PO16) & Supplemental Benefits

Health Insurance for Retirees with Medicare

Enrolled in Medicare? Learn about the key differences between our Medicare-coordinated plan design options, costs for medical services, available health plans and monthly premium amounts

Plan Year
  • 2025
Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits

Health Insurance for Retirees with Medicare

Enrolled in Medicare? Learn about the key differences between our Medicare-coordinated plan design options, costs for medical services, available health plans and monthly premium amounts

Plan Year
  • 2025
Program Option
  • Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits

Health Insurance for Retirees with Medicare

Enrolled in Medicare? Learn about the key differences between our Medicare-coordinated plan design options, costs for pharmacy services, available health plans and monthly premium amounts

Plan Year
  • 2025
Program Option
  • Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits