As part of our modernization journey, ETF is partnering with Benefitfocus to implement a best practices-based, fully integrated Insurance Administration System (IAS), known as My Insurance Benefits.
A tool for an employer to confirm information was presented to a new employee, due dates identified and appropriate information and forms supplied for all ETF-administered benefits offered by the employer.
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.
ET-2340
Form
Active Employee /
Local Employer /
State Employer
A tool for an employer to confirm information was presented to a new employee, due dates identified and appropriate information and forms supplied for all ETF-administered benefits offered by the employer.