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.
Benefit Enrollment Opportunities Learn about the times throughout the year when you may enroll in health and supplemental insurance benefits, or change your coverage. Plan Year 2024 Program Option State Employee and Retiree Health Plan & Supplemental Benefits
Benefit Enrollment Opportunities Learn about the times throughout the year when you may enroll in health and supplemental insurance benefits, or change your coverage. Plan Year 2025 Program Option State Employee and Retiree Health Plan & Supplemental Benefits
You Marry Experiencing this life event may allow you to make changes to your accident plan or health, dental, vision, or long-term care insurance. 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