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Cancellation or Termination of Health Coverage FAQs

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

Health and Wellness News

Oct 10, 2024 12:00pm

Icon representing medicine bottle and virus

Preventive Care and Drugs Coverage in 2025

Open enrollment runs until Oct. 25, 2024. Learn about preventive care and drugs coverage in 2025, where to get free vaccines, diabetes management program, and more.

25ET-2107upb

Brochure Active Employee / Retiree / Local Employer / State Employer

2025 Uniform Pharmacy Benefits Certificate of Coverage

Uniform Pharmacy Benefits Certificate of Coverage for the 2025 plan year, for all program options.

26ET-2107upb

Brochure Active Employee / Retiree / Local Employer / State Employer

2026 Uniform Pharmacy Benefits Certificate of Coverage

Uniform Pharmacy Benefits Certificate of Coverage for the 2026 plan year, for all program options.

ET-4814

Form Active Employee / Retiree / Local Employer

Local Employer Verification of Health Insurance Coverage

Local employers, complete to submit verification for an employee's or local-paid retiree's health insurance coverage.

ET-8106

Brochure Active Employee / Retiree / Local Employer / State Employer

Department of Employee Trust Funds Public Records Notice

ETF will, consistent with the state’s Public Records Law, provide information regarding ETF’s affairs, except for individual personal information restricted by statute.

Medicare Information FAQs

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

Equal Employment Opportunity Commission (EEOC) Notice Regarding Wellness Program

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

Dental Insurance Coverage

See what is covered under the Uniform Dental Plan, Preventive Plan, Select Plan, and Select Plus Plans.

ET-4307

Form Active Employee / Retiree

Medicare Eligibility Statement

You and/or your insured dependents must be enrolled for both portions of Medicare (Hospital Part A and Medical Part B), when first eligible. Provide this information to ETF using this form.