ET-4111
Form Retiree

Medicare Enrollment for Disability Retirees

If you retired due to a disability, you may be eligible for Medicare benefits. Medicare eligibility related to disability is available to persons who have received Social Security disability benefits for at least 24 months, who have End Stage Renal Disease (ESRD), or Lou Gehrig’s Disease (ALS).

ET-4307
Form Active Employee / Retiree

Medicare Eligibility Statement

You and/or your insured dependents must be enrolled for both portions of Medicare (Hospital Part A and Medical Part B), when first eligible. Provide this information to ETF using this form.

ET-2106
Brochure Active Employee / State Employer

Income Continuation Insurance - State

The income continuation insurance ICI benefit is a voluntary “income replacement” benefit payable if you become disabled.

Health and Wellness News
Oct 23, 2024 12:00pm
Doctor listening to heartbeat of child with parent

Open Enrollment Ends This Friday!

Learn about our Insurance Help page, how to contact Health Plan and Vendors, additional benefits from Delta Dental, and other mental health support programs.

Health Plan Quality

Health plans are evaluated on key care delivery areas such as disease management and customer satisfaction. You can use quality resources to make an informed decision about which health plan is right for you.

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
Plan Year
  • 2025