Notice of Creditable Coverage for Medicare Part D 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
ACA: Marketplace Health Insurance Coverage Options Notice 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
24ET-2100ccd Brochure Retiree 2024 Medicare Advantage Evidence of Coverage - Deductible Medicare Advantage, with deductible, Evidence of Coverage for the 2024 plan year.
25ET-2100ccd Brochure Retiree 2025 Medicare Advantage Evidence of Coverage - Deductible Medicare Advantage, with deductible, Evidence of Coverage for the 2025 plan year.
25ET-4113 Brochure Retiree / Local Employer / State Employer 2025 Medicare Plus Certificate of Coverage Certificate of Coverage for the Medicare Plus Plan for the 2025 plan year.
24ET-4113 Brochure Retiree / Local Employer / State Employer 2024 Medicare Plus Certificate of Coverage Certificate of Coverage for the Medicare Plus Plan for the 2024 plan year.
24ET-2100cc Brochure Retiree 2024 Medicare Advantage Evidence of Coverage - Non-deductible This Evidences of Coverage provides details about Medicare health care coverage from January 1, 2024 - December 31, 2024.
25ET-2100cc Brochure Retiree 2025 Medicare Advantage Evidence of Coverage - Non-deductible This Evidence of Coverage provides details about Medicare health care coverage for the 2025 plan year.
ET-2314a Form Local Employer / State Employer Model COBRA Subsidy Notice This is the Model Notice for COBRA Continuation Subsidy under the American Rescue Plan [ARP] Act of 2021. Employers please note that information for qualified beneficiaries must be completed.
Medicare Information FAQs 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 Plan Year 2025