Health Insurance Employer Forms

Use the forms on this page to administer the Group Health Insurance program. If you are not finding what you need, go to the Publications page to search through all publications.

Preventive Care Services Covered at 100%

Your health plan pays 100% of certain preventive care services with no out-of-pocket costs to you.

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

Breakdown of Your Costs by Plan Design

Learn how much you can expect to pay when you visit the doctor, get an X-ray, and more.
Plan Year
    2025
Program Option
    Local High Deductible Health Plan (PO17) & Supplemental Benefits

Breakdown of Your Costs by Plan Design

Learn how much you can expect to pay when you visit the doctor, get an X-ray, and more.
Plan Year
    2025
Program Option
    Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits
Employer News
Aug 28, 2024 1:00pm

Local Employer Resolutions Due October 1, 2024

Any employers interested in joining a WPE benefit program or changing their program offerings must file their resolution before October 1. ETF expects this resolution suspension to last through 2025.