ET-4317
Form Active Employee / Retiree

Sick Leave Re-enrollment Application

Re-enroll for group health insurance coverage during the annual It’s Your Choice open enrollment period or after an involuntary loss of your comparable non-state coverage, if eligible.

ET-2385
Form Active Employee / Local Employer / State Employer

Health Savings Account (HSA) Enrollment

For UWs use only, as a paper alternative for a member who cannot complete their HSA enrollment online.

Man at computer with cup of coffee

How to Choose & Enroll in Your Benefits

Here for open enrollment? Just start a new job? Or have a baby? Start here to find out when you can enroll or make changes to your benefits and the steps to make those changes

Plan Year
  • 2025
Program Option
  • Local High Deductible Health Plan (PO17) & Supplemental Benefits
Man at computer with cup of coffee

How to Choose & Enroll in Your Benefits

Here for open enrollment? Just start a new job? Or have a baby? Start here to find out when you can enroll or make changes to your benefits and the steps to make those changes

Plan Year
  • 2025
Program Option
  • Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits
Man at computer with cup of coffee

How to Choose & Enroll in Your Benefits

Here for open enrollment? Just start a new job? Or have a baby? Start here to find out when you can enroll or make changes to your benefits and the steps to make those changes

Plan Year
  • 2025
Program Option
  • Local Traditional Health Plan (PO12) & Supplemental Benefits