This brochure can help you complete a retirement application. It also covers general topics and provides answers to questions frequently asked by members that met with a benefits specialist in person.
ET-4303
Form
Active Employee /
Local Employer /
State Employer
Form for elected officials to irrevocably waive further participation in the WRS for current, and any future, service as an elected official that does not exceed 1,044 hours per year.
Income received from the WebMD program or the Wellness Incentive from your health plan provider is taxable. You will receive a W-2 statement from ETF if you are covered under the state group health insurance program and you and/or your dependents received a wellness incentive from your health plan provider or from WebMD.
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
Once an employee returns to work with his or her pre-military leave of absence employer, the employer is required to submit this form along with a copy of the appropriate military paperwork.
Report
Active Employee /
Retiree /
Other Benefit Recipient /
Board Member /
Local Employer /
State Employer
