ET-2314a
Form Local Employer / State Employer

Model COBRA Subsidy Notice

This is the Model Notice for COBRA Continuation Subsidy under the American Rescue Plan [ARP] Act of 2021. Employers please note that information for qualified beneficiaries must be completed. 

Notice of Privacy Practices

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
Employer News
Apr 4, 2024 9:00am
Statement on computer image

2024 WRS Annual Statement of Benefits Coming Soon

The WRS Annual Statement of Benefits will soon be delivered to active employees with WRS contribution balances as of December 31, 2022. Note: All active employees will receive their statement in the mail.

Limited Purpose Flexible Spending Account (LPFSA)

Only available to participants enrolled in a High Deductible Health Plan (HDHP).

A Limited Purpose Flexible Spending Account (LPFSA) is a pre-tax benefit used to pay for eligible dental, vision care, and post-deductible medical expenses. You may use these funds to pay for eligible expenses incurred by you, your spouse, and your qualified dependents.

Plan Year
  • 2025
Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits

Transit Account

A Transit Account allows you use pre-tax dollars to pay for eligible mass transit expenses related to your commute to and from work.

Plan Year
  • 2025
Program Option
  • State Employee and Retiree Health Plan & Supplemental Benefits