Once an employee returns to work with his or her pre-military leave of absence employer, the employer is required to submit this form along with a copy of the appropriate military paperwork.
A benefit may be paid during your lifetime or upon your death. You or your beneficiary must make sure to follow the correct steps to receive your benefit.
The Duty Disability Insurance Program is an income replacement program. Duty disability benefits may be payable to protective occupation participants if you have been injured while performing your duties or contracted a disease due to your occupation.
Notice for members where all or a portion of a payment from the WRS is eligible to be rolled over to an individual retirement account (IRA) or an employer plan.
ET-4112
Brochure
Active Employee /
Retiree /
Local Employer /
State Employer
If you are eligible to enroll in or change plans due to a qualified life change event, you may be asked to provide documents (employees to your employer, retirees to ETF) to confirm your eligibility.
Program Option
Local Annuitant Health Program (LAHP)
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-4925
Brochure
Active Employee /
Retiree /
Other Benefit Recipient
This brochure is designed to assist you in understanding the administrative appeals process as it relates to ETF. It is not intended to substitute for the legal advice or assistance of an attorney.
ET-2305
Form
Active Employee /
Local Employer /
State Employer
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.