Your employer may pay a portion of your health care premium if you're employed. This page lists the full premium amounts, which is the amount before any employer contribution.
Plan Year
2025
Program Option
Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits
Your employer may pay a portion of your health care premium if you're employed. This page lists the full premium amounts, which is the amount before any employer contribution.
Plan Year
2025
Program Option
Local High Deductible Health Plan (PO17) & Supplemental Benefits
Your employer may pay a portion of your health care premium if you're employed. This page lists the full premium amounts, which is the amount before any employer contribution.
Your employer may pay a portion of your health care premium if you're employed. This page lists the full premium amounts, which is the amount before any employer contribution.
Plan Year
2025
Program Option
Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits
Your employer may pay a portion of your health care premium if you're employed. This page lists the full premium amounts, which is the amount before any employer contribution.
Plan Year
2025
Program Option
Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits
Your employer may pay a portion of your health care premium if you're employed. This page lists the full premium amounts, which is the amount before any employer contribution.
Plan Year
2025
Program Option
Local Deductible Health Plan (PO14) & Supplemental Benefits
Your employer may pay a portion of your health care premium if you're employed. This page lists the full premium amounts, which is the amount before any employer contribution.
Program Option
Local Traditional Health Plan (PO12) & Supplemental Benefits
Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits
Plan Year
2026
ET-4620
Form
Active Employee /
Local Employer /
State Employer
This application is intended for insured employees who are terminating private pension employment, who may qualify to continue life insurance coverage.
Your employer may pay a portion of your health care premium if you're employed. This page lists the full premium amounts, which is the amount before any employer contribution.
Plan Year
2025
Program Option
Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits