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.
Income received from the WebMD program or the Wellness Incentive from your health plan provider is taxable. You will receive a W-2 statement from ETF if you are covered under the state group health insurance program and you and/or your dependents received a wellness incentive from your health plan provider or from WebMD.
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
Your employer may pay a portion of your health care premium if you're employed. This page lists the full premium amounts, which is the amount before any employer contribution.
Plan Year
2024
Program Option
Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits
Your employer may pay a portion of your health care premium if you're employed. This page lists the full premium amounts, which is the amount before any employer contribution.
Plan Year
2024
Program Option
Local Deductible Health Plan (PO14) & Supplemental Benefits
Your employer may pay a portion of your health care premium if you're employed. This page lists the full premium amounts, which is the amount before any employer contribution.
Plan Year
2024
Program Option
Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits
Enrolled in Medicare? Learn about the key differences between our Medicare-coordinated plan design options, costs for pharmacy services, available health plans and monthly premium amounts
Plan Year
2024
Program Option
Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits
Your employer may pay a portion of your health care premium if you're employed. This page lists the full premium amounts, which is the amount before any employer contribution.
Plan Year
2024
Program Option
Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits