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.
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
Employer News Apr 3, 2025 11:00am 2025 WRS Annual Statement of Benefits Coming Soon The WRS Annual Statement of Benefits will soon be delivered to active employees with WRS contribution balances as of December 31, 2024.
