ET-5306
Form Local Employer / State Employer

Request for Disability Premium Waiver

Employers should submit this form when first aware that an insured employee is unable to work due to illness or injury and will be unable to perform any work or to engage in any occupation for an indefinite period.

Report Active Employee / Retiree / Board Member / Local Employer / State Employer

Duty Disability Program Actuarial Valuation 2022

This report presents the results of the annual actuarial valuation of benefit liabilities and costs of the Duty Disability Program as of December 31, 2022.

Report Active Employee / Retiree / Board Member / Local Employer / State Employer

Duty Disability Plan Actuarial Valuation 2008

This report presents the results of the annual actuarial valuation of benefit liabilities and costs of the Duty Disability Program as of December 31, 2008.

Report Active Employee / Retiree / Board Member / Local Employer / State Employer

Duty Disability Program Actuarial Valuation 2009

This report presents the results of the Annual Actuarial Valuation of benefit liabilities and costs of the Duty Disability Program as of December 31, 2009.

Report Active Employee / Retiree / Board Member / Local Employer / State Employer

Duty Disability Program Actuarial Valuation 2004

This report presents the results of the annual actuarial valuation of benefit liabilities and costs of the Duty Disability Program as of December 31, 2004.

Report Active Employee / Retiree / Board Member / Local Employer / State Employer

Duty Disability Program Actuarial Valuation 2006

This report presents the results of the annual actuarial valuation of benefit liabilities and costs of the Duty Disability Program as of December 31, 2006.

Report Active Employee / Retiree / Board Member / Local Employer / State Employer

Duty Disability Program Actuarial Valuation 2007

This report presents the results of the annual actuarial valuation of benefit liabilities and costs of the Duty Disability Program as of December 31, 2007.

Report Active Employee / Retiree / Local Employer / State Employer

Duty Disability Program Actuarial Valuation 2005

This report presents the results of the annual actuarial valuation of benefit liabilities and costs of the Duty Disability Program as of December 31, 2005.

You Have a Job Change Where You Gain a Greater Share of Employer Contribution Toward Your Coverage (Active Employees Only)

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 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

You Have a Job Change Where You Lose a Significant Share of Employer Contribution Toward Your Coverage (Active Employees Only)

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 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