Employees who did not enroll for group life insurance coverage during their initial enrollment period, or insured employees who wish to apply for more insurance for themselves or their spouse or dependents, may apply using this form.
Learn how your sick leave credits are calculated for Accumulated Sick Leave Credit Conversion (ASLCC) and Supplemental Health Insurance Conversion Credit (SHICC).
ET-4427
Form
Active Employee /
Retiree /
Other Benefit Recipient
Form for the member’s physician to complete if the member cannot manage property, finances or business affairs because of an impairment in the ability to receive and evaluate information or make or communicate decisions even with the use of technological assistance.
This plan document provides provisions on the Commuter Fringe Benefits Accounts, such as plan administration, eligibility, participation, and termination.