ET-4427
Form Active Employee / Retiree / Other Benefit Recipient

Statement of Incapacity for Finances and Property

Form for the member’s physician to complete if the member cannot manage property, finances or business affairs because of an impairment in the ability to receive and evaluate information or make or communicate decisions even with the use of technological assistance.

Your Unmarried Dependent Over Age 26 Becomes Disabled and Gains Eligibility

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

HDHP Eligibility

A few eligibility requirements include:

You must be covered by a High Deductible Health Plan (HDHP) and enrolled in the Health Savings Account (HSA) offered by ETF.

You cannot have any other health coverage that pays for out-of-pocket health care expenses before you meet your plan deductible (including Medicare).

Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits
Plan Year
  • 2025
A hand on a a walking stick.

Disability Benefits

If you become disabled while working for a WRS employer, you may be eligible to receive WRS disability benefits that will give you income for the time you are unable to return to work.

Annual Requirements for Disability Benefits

Each year, recipients of disability benefits must complete and submit form(s) to ensure that their benefits continue without interruption. It is crucial that all required forms are submitted timely to prevent suspension of the benefit.