ET-7414 Form Active Employee / Retiree / Other Benefit Recipient Authorization to Disclose Medical Information This form gives ETF and entities that perform contracted services for ETF permission to release your designated medical information to a person or entity specified by you.
Guide to Office Visit Copays A quick reference for how much you'll pay when you visit the doctor. Program Option 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 Plan Year 2024