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-8900 Active Employee / Retiree / Local Employer / State Employer Employee Reimbursement Accounts Fact Sheet The Employee Reimbursement Accounts (ERA) Program is an optional benefit that allows participants to use pre-tax dollars to pay for certain Internal Revenue Service-approved expenses.
24ET-2108sb Brochure Retiree 2024 Schedule of Benefits: Health Plan Medicare & Local Traditional Plan (PO1, PO2/12, PO6/16, PO7/17, PO8) The Schedule of Benefits explains what medical services the Group Health Insurance Program (GHIP) covers and what you pay for covered services.
25ET-2108sb Brochure Retiree 2025 Schedule of Benefits: Health Plan Medicare & Local Traditional Plan (PO1, PO2/12, PO6/16, PO7/17, PO8) The Schedule of Benefits explains what medical services the Group Health Insurance Program (GHIP) covers and what you pay for covered services.
24ET-2107sb Brochure Active Employee 2024 Schedule of Benefits: IYC Health Plan (PO1, PO6/16, PO8) The Schedule of Benefits explains what medical services the Group Health Insurance Program (GHIP) covers and what you pay for covered services.
24ET-2107sbhd Brochure Active Employee 2024 Schedule of Benefits: High Deductible Health Plan (HDHP) (PO1, PO7/17) The Schedule of Benefits explains what medical services the Group Health Insurance Program (GHIP) covers and what you pay for covered services.
25ET-2107sb Brochure Active Employee 2025 Schedule of Benefits: IYC Health Plan (PO1, PO6/16, PO8) The Schedule of Benefits explains what medical services the Group Health Insurance Program (GHIP) covers and what you pay for covered services.
25ET-2107sbhd Brochure Active Employee 2025 Schedule of Benefits: High Deductible Health Plan (HDHP) (PO1, PO7/17) The Schedule of Benefits explains what medical services the Group Health Insurance Program (GHIP) covers and what you pay for covered services.
24ET-2158sb Brochure Active Employee 2024 Schedule of Benefits: Local Deductible Plan (PO4/14) The Schedule of Benefits explains what medical services the Group Health Insurance Program (GHIP) covers and what you pay for covered services.
25ET-2158sb Brochure Active Employee 2025 Schedule of Benefits: Local Deductible Plan (PO4/14) The Schedule of Benefits explains what medical services the Group Health Insurance Program (GHIP) covers and what you pay for covered services.