ET-4303
Form Active Employee / Local Employer / State Employer

Waiver of Part-Time Elected Service

Form for elected officials to irrevocably waive further participation in the WRS for current, and any future, service as an elected official that does not exceed 1,044 hours per year.

W-2 Wellness Incentive Taxes

Income received from the WebMD program or the Wellness Incentive from your health plan provider is taxable. You will receive a W-2 statement from ETF if you are covered under the state group health insurance program and you and/or your dependents received a wellness incentive from your health plan provider or from WebMD.

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-4121
Brochure Active Employee

Buying Creditable Service

This brochure describes the types of service you may be eligible to buy, the benefits and restrictions on the purchases, and how and when you can buy service.

Deferred Compensation Board
Employer News
Jun 10, 2022 8:00am

Local Health Insurance Manual (ET-1144) Updated June 2022

ETF has updated the Local Employer Health Insurance Standards, Guidelines, and Administration Employer Manual (ET-1144), and has summarized the changes in the table below.  Please disregard any previous versions of this manual.

ET-6301
Form Other Benefit Recipient

Notice of Death

Notify the third party administrator of the group life insurance program of a member death.

Free or Low-Cost Health Coverage to Children and Families

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