ET-7414 Form Active Employee / Retiree / Other Benefit Recipient Authorization to Disclose Medical Information 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.
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2024 Program Option State Employee and Retiree Health Plan & Supplemental Benefits
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2024 Program Option Local Annuitant Health Program (LAHP)
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2024 Program Option Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2024 Program Option Local High Deductible Health Plan (PO17) & Supplemental Benefits
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2024 Program Option Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2024 Program Option Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2024 Program Option Local Health Plan (PO16) & Supplemental Benefits
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2025 Program Option Local High Deductible Health Plan (PO17) & Supplemental Benefits
Breakdown of Your Costs by Medicare Plan Design Lists the costs of common health services for each plan design. Plan Year 2025 Program Option Local Health Plan (PO16) & Supplemental Benefits