You or Your Dependent Involuntarily Lose Eligibility or All Employer Contribution for Other Group Medical Coverage

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 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
ET-2321
Form Active Employee / Retiree

Beneficiary Designation - Alternate

If you wish to specify who shall receive a primary beneficiary’s share of a death or life insurance benefit if a primary beneficiary is deceased, you must use this alternate beneficiary designation form.

ET-8918
Active Employee / Retiree / Local Employer / State Employer

Income Continuation Insurance-State Fact Sheet

Income Continuation Insurance (ICI) is an optional insurance that provides replacement income for disabilities that are considered short-term in nature, as well as those which may last for extended periods.

ET-8931
Active Employee / Retiree / Local Employer / State Employer

Income Continuation Insurance-Local Fact Sheet

Income Continuation Insurance (ICI) is an optional insurance that provides a replacement income for disabilities that are considered short-term in nature, as well as those which may last for extended periods.