ET-2405 Form Active Employee / Retiree ETF Insurance Complaint Form If you filed a grievance with the plan or benefit administrator and are dissatisfied with the final decision, you can request an administrative review from ETF.
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
Summary of Benefits and Coverage A snapshot of a health plan's costs, benefits, covered healthcare services, and other important features. Plan Year 2024 Program Option Local Annuitant Health Program (LAHP)
Summary of Benefits and Coverage A snapshot of a health plan's costs, benefits, covered healthcare services, and other important features. Program Option Local Annuitant Health Program (LAHP) Local Health Plan (PO16) & Supplemental Benefits Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits Plan Year 2024
Summary of Benefits and Coverage A snapshot of a health plan's costs, benefits, covered healthcare services, and other important features. Program Option Local Traditional Health Plan (PO12) & Supplemental Benefits Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits Plan Year 2024
Summary of Benefits and Coverage A snapshot of a health plan's costs, benefits, covered healthcare services, and other important features. Program Option Local High Deductible Health Plan (PO17) & Supplemental Benefits Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits Plan Year 2024
Submit, Change, or Terminate Letters of Guardianship Learn the steps to submit, change or terminate Letters of Guardianship.
Health Insurance for Employees, COBRA and Retirees without Medicare Learn about the key differences between your plan design options, costs for medical services, available health plans and monthly premium amounts Plan Year 2024 Program Option State Employee and Retiree Health Plan & Supplemental Benefits
Create, Submit, or Revoke A Financial Power of Attorney Document Find resources for creating a financial power of attorney document, learn how to submit your document to ETF and how to revoke your document.
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