ET-2339 Form Active Employee / Retiree Supplemental Insurance Application/Change For UWs use only, as a paper alternative for a member who cannot complete their supplemental insurance enrollments online.
Enrollment Information Learn how to enroll in a pre-tax saving account during open enrollment, as a new hire, or when you have experienced a qualifying life event. Program Option State Employee and Retiree Health Plan & Supplemental Benefits Plan Year 2026