Changes in Employment Status 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
ET-5352 Form Active Employee Income Continuation Insurance Claim Instructions Use this form to file a paper income continuation insurance (ICI) claim.
ET-5901 Form Local Employer / State Employer Income Continuation Insurance Report of Employment and Earnings Employers, complete this form to notify ETF of a claimant’s change in work status and/or earnings paid to the individual after the elimination period.
Local Employer / State Employer Annual Reporting Account Update Instructions Directions for employers to report their annual reconciliation through the Account Update Application by manually entering an annual transaction for every WRS-eligible employee at your employer.
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