This form gives ETF and entities that perform contracted services for ETF permission to release your designated medical information to a person or entity specified by you.
Level 4 self-injectables and specialty medications are available through specific pharmacies for non-Medicare members while members on Medicare have some additional pharmacy options.
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
Have you ever needed medical care and didn’t know where to turn? In this video you'll learn about your care options and the advantages of each, including which is easiest on the wallet.
ET-8106
Brochure
Active Employee /
Retiree /
Local Employer /
State Employer
ETF will, consistent with the state’s Public Records Law, provide information regarding ETF’s affairs, except for individual personal information restricted by statute.
