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.
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2024 Program Option Local Annuitant Health Program (LAHP)
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2024 Program Option Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2024 Program Option Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2024 Program Option Local Health Plan (PO16) & Supplemental Benefits
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2024 Program Option State Employee and Retiree Health Plan & Supplemental Benefits
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2024 Program Option Local High Deductible Health Plan (PO17) & Supplemental Benefits
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2024 Program Option Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2024 Program Option Local Traditional Health Plan (PO12) & Supplemental Benefits
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2024 Program Option Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits