ET-2301 Form Active Employee / Local Employer / State Employer Health Insurance Application/Change Form Enroll in health insurance or change your coverage.
You Are Laid off or Start a Leave of Absence (Active Employees Only) Experiencing this life event may allow you to make changes to your accident plan or health, dental, vision, or long-term care insurance. Program Option 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
You Divorce Experiencing this life event may allow you to make changes to your accident plan or health, dental, vision, or long-term care insurance. 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
ET-2500 Form State Employer Termination Checklist For Retiring State Employees A checklist for state employers to use when an employee is terminating due to retirement.
24ET-2156 Brochure Retiree / Local Employer 2024 Health Benefits Decision Guide: Local Annuitant Health Program (LAHP) 2024 Local Annuitant Health Program health benefits decision guide for certain local retirees and surviving dependents.
Employer and Employee Responsibilities Use the information on this page to know when to submit a sick leave certification and in the appropriate timeframe.