You Divorce 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
ET-4944 Form Active Employee / Retiree / Other Benefit Recipient Limited Power-of-Attorney for Appeal Designate an attorney-in-fact to act in your stead for an appeal to ETF.
ET-1111 Manual Local Employer / State Employer Employer Insurance Administration System (IAS) Procedures For UWs only: These procedures will walk employers through steps to take in My Insurance 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 Have a New Dependent 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
25ET-2107upb Brochure Active Employee / Retiree / Local Employer / State Employer 2025 Uniform Pharmacy Benefits Certificate of Coverage Uniform Pharmacy Benefits Certificate of Coverage for the 2025 plan year, for all program options.
24ET-2107upb Brochure Active Employee / Retiree / Local Employer / State Employer 2024 Uniform Pharmacy Benefits Certificate of Coverage Uniform Pharmacy Benefits Certificate of Coverage for the 2024 plan year, for all program options.
25ET-4113 Brochure Retiree / Local Employer / State Employer 2025 Medicare Plus Certificate of Coverage Certificate of Coverage for the Medicare Plus Plan for the 2025 plan year.
24ET-4113 Brochure Retiree / Local Employer / State Employer 2024 Medicare Plus Certificate of Coverage Certificate of Coverage for the Medicare Plus Plan for the 2024 plan year.
