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
ET-4938
Form Active Employee / Retiree / Other Benefit Recipient

Appeal Form

Submit this completed form to ETF to appeal a determination regarding your ETF-administered benefit(s).

Report Active Employee / Retiree / Board Member / Local Employer / State Employer

Long-Term Disability Insurance Actuarial Valuation 2012

This report presents the results of the annual actuarial valuation of benefit liabilities and costs of the Long-Term Disability Insurance Plan (LTDI) as of December 31, 2012.

Report Active Employee / Retiree / Board Member / Local Employer / State Employer

Long-Term Disability Insurance Actuarial Valuation 2013

This report presents the results of the annual actuarial valuation of benefit liabilities and costs of the Long-Term Disability Insurance Plan (LTDI) as of December 31, 2013.