ET-4307
Form Active Employee / Retiree

Medicare Eligibility Statement

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.

26ET-2180
Brochure Active Employee / Retiree / Other Benefit Recipient / Local Employer / State Employer

2026 Uniform Benefits Certificate of Coverage

This 2026 Certificate of Coverage is your Summary Plan Description and contains the Uniform Benefits offered under the Group Health Insurance Program.

25ET-2180
Brochure Active Employee / Retiree / Other Benefit Recipient / Local Employer / State Employer

2025 Uniform Benefits Certificate of Coverage

This Certificate of Coverage is your Summary Plan Description and contains the Uniform Benefits offered under the Group Health Insurance Program.