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.

Summary of Benefits and Coverage

A snapshot of a health plan's costs, benefits, covered healthcare services, and other important features.

Program Option
  • Local Deductible Health Plan (PO14) & Supplemental Benefits
  • Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits
Plan Year
  • 2026

Summary of Benefits and Coverage

A snapshot of a health plan's costs, benefits, covered healthcare services, and other important features.

Program Option
  • Local Annuitant Health Program (LAHP)
  • Local Health Plan (PO16) & Supplemental Benefits
  • Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits
Plan Year
  • 2026

Summary of Benefits and Coverage

A snapshot of a health plan's costs, benefits, covered healthcare services, and other important features.

Program Option
  • Local High Deductible Health Plan (PO17) & Supplemental Benefits
  • Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits
Plan Year
  • 2026

Summary of Benefits and Coverage

A snapshot of a health plan's costs, benefits, covered healthcare services, and other important features.

Program Option
  • Local Traditional Health Plan (PO12) & Supplemental Benefits
  • Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits
Plan Year
  • 2026
Nationwide Access, Out-Of-Network Benefits, Higher Premium

Access Plan by Dean

Major Health Systems

Search for a provider on First Health’s Locate a Provider webpage.

Full Service Areas
  • United States
Limited Service Areas
  • Worldwide