This application is intended for insured employees who are terminating private pension employment, who may qualify to continue life insurance coverage.
Local county employers, please distribute this form to your jailers so they can record their decision to be either a general category employee or a protective category employee for WRS benefit purposes.
A Health Care Flexible Spending Account (FSA) allows you to set aside tax-free dollars each year for health care expenses not covered by insurance. You may use these funds to pay for eligible health care expenses incurred by you, your spouse, and your qualified dependents.
Plan Year
2026
Program Option
State Employee and Retiree Health Plan & Supplemental Benefits
Report
Active Employee /
Board Member /
Local Employer /
State Employer