Use the directions on this page to help you complete your application form. The directions will help you to complete an accurate retirement application and avoid mistakes that would cause rejection.
ET-7414
Form
Active Employee /
Retiree /
Other Benefit Recipient
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.
If you are eligible to enroll in or change plans due to a qualified life change event, you may be asked to provide documents (employees to your employer, retirees to ETF) to confirm your eligibility.
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
A guardian is appointed by a court when a person is unable to make or communicate medical decisions, financial decisions, or both. Learn how Letters of Guardianship can impact a WRS account.
ET-4925
Brochure
Active Employee /
Retiree /
Other Benefit Recipient
Your WRS account information is confidential, and no one can receive information about or make changes to your account unless authorized. You can authorize another person to make changes to your account by submitting a financial power of attorney document to ETF.
ET-6101
Brochure
Active Employee /
Retiree /
Other Benefit Recipient
