ET-2340 Form Active Employee / Local Employer / State Employer Automatic Premium Conversion Waiver/Revocation of Waiver Complete this form to waive your participation in automatic premium conversion, or to revoke a waiver of premium conversion that you filed previously.
ET-2129 Brochure Active Employee Income Continuation Insurance - Local The income continuation insurance (ICI) benefit is a voluntary income replacement benefit payable if you become disabled.
ET-5352 Form Active Employee Income Continuation Insurance Claim Instructions Use this form to file a paper income continuation insurance (ICI) claim.
ET-4925 Brochure Active Employee / Retiree / Other Benefit Recipient How Divorce Can Affect Your WRS Benefits Information on how a divorce may affect WRS benefits, beneficiary designations as well as information for the alternate payee.
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.
HSA Eligibility There are a number of requirements you must meet in order to be eligible for an HSA. Program Option State Employee and Retiree Health Plan & Supplemental Benefits Plan Year 2024
COBRA / Continuation 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
ET-2366 Form Active Employee / Local Employer Income Continuation Insurance Application--Local Employee Complete and then submit to your employer to apply for income continuation insurance.
COBRA/Continuation of Health Coverage FAQs Program Option State Employee and Retiree Health Plan & Supplemental Benefits Plan Year 2024
ET-2308 Form Active Employee Evidence of Insurability Instructions—Income Continuation Insurance (ICI) This application allows you to apply to enroll in the Income Continuation Insurance (ICI) Program if you did not enroll when originally eligible or if coverage was canceled.