Health Savings Accounts (HSAs)

Only available to participants enrolled in a High Deductible Health Plan (HDHP).

A Health Savings Account (HSA) is an individually-owned, tax-advantaged account that you can use to pay for current or future eligible medical expenses. With an HSA, you’ll have the potential to build more savings for health care expenses or additional retirement savings through self-directed investment options.

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

Find the Cost of Your Drugs

Employees and Retirees without Medicare: learn how much you can expect to pay at the pharmacy.

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 Traditional Health Plan (PO12) & Supplemental Benefits
  • Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits
Plan Year
  • 2025

Find the Cost of Your Drugs (Medicare)

Retirees with Medicare: learn how much you can expect to pay at the pharmacy.

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
Plan Year
  • 2025
ET-4427
Form Active Employee / Retiree / Other Benefit Recipient

Statement of Incapacity for Finances and Property

Form for the member’s physician to complete if the member cannot manage property, finances or business affairs because of an impairment in the ability to receive and evaluate information or make or communicate decisions even with the use of technological assistance.

Your Spouse or Dependent Dies

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 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

Pre-Tax Savings Accounts

Save on a wide variety of everyday medical, dental, vision, day care, parking, and transit expenses with a pre-tax savings account. It’s a tax break that’s simple to use.

Plan Year
  • 2025
Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits
ET-8945
Form Other Benefit Recipient

Vendor Privacy Incident Report

Use this form to report any possible or confirmed breaches of protected health information (PHI) or personally identifiable information (PII).

Summary of Benefits and Coverage

A snapshot of a health plan's costs, benefits, covered healthcare services, and other important features.

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

Steps to Choosing Your Benefits

Not sure where to start? This page is a step-by-step guide to choosing your benefits.

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