You and/or your insured dependents must be enrolled for both portions of Medicare (Hospital Part A and Medical Part B), when first eligible. Provide this information to ETF using this form.
Save on a wide variety of everyday medical, dental, vision, day care, parking, and transit expenses with a pre-tax savings account. It’s a tax break that’s simple to use.
Plan Year
2024
Program Option
State Employee and Retiree Health Plan & Supplemental Benefits
ET-2331
Form
Retiree /
Other Benefit Recipient /
Local Employer /
State Employer
Please note this major change: this manual no longer contains sick leave information. You can now find complete sick leave information in the new Sick Leave Conversion Program Employer Manual (ET-1170).
23ET-2107upb
Brochure
Active Employee /
Retiree /
Local Employer /
State Employer