Employers, use this form to verify that you viewed the employee’s original required document(s) to verify the employee or dependent(s) is eligible for benefit coverage, as administered by ETF.
Employer certification that a WRS annuity or lump-sum payment made to the survivor of the member named in this form may be eligible for an income tax exemption.
ET-4620
Form
Active Employee /
Local Employer /
State Employer
This application is intended for insured employees who are terminating private pension employment, who may qualify to continue life insurance coverage.
ICI is a voluntary “income replacement” benefit payable to an enrolled employee if they become disabled. This program is only
offered to employers already participating in the WRS.
A resource to keep local employers informed about the new Insurance Administration System project and the status of the implementation. Local employers can learn about the project, register for upcoming meetings, and view past meeting recordings.