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.
ETF requires a member’s ITIN or SSN to administer benefits. What should employers do when you have employees or their dependents without one of these numbers?
The Basic group life insurance plan became available to state employees in 1958 and to local government employees in 1960. Spouse & Dependent, Supplemental and Additional coverage is also available.
The new manual provides information about the Sick Leave Conversion Program, including that unused sick leave can be utilized as a retirement benefit that allows eligible employees to convert unused sick leave into credits to pay post-termination health insurance premiums.
This training is for all state and local employers who use myETF Benefits to enroll new employees in benefits, view and update health insurance information, view and update demographic information, or complete terminations. See what form to complete for access, where to log in, and how to navigate myETF Benefits.
The Group Life Insurance Program is available to all state employers. Watch ETF’s newest training video to explore the basics of this program and have your questions answered.
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.