- Summary Plan Document ET-2129 (Link)
- Enrollment/Change Form ET-2366 (Link)
- Evidence of Insurability Form ET-2308 (Link)
- Frequent Asked Questions Regarding ICI (Link)
You can initiate a claim by calling the ICI administrator, at 1-800-960-0052. When your claim is initiated, the claims administrator will send you an introductory packet including a medical release and complete claims processing information.
A claim may be submitted to the ICI administrator up to thirty (30) days prior to the last day worked; however, no benefits will be payable until after the last day worked based on the first date of disability determined by the administrator and subject to your elimination period. In no event will a claim be approved if received more than twelve (12) months from the claimed first date of disability. In addition, no benefits will be payable for the period which is more than ninety (90) days prior to the date ETF receives the paper claim form or the administrator receives the telephone claim.
Contact Sharon Hernandez, Employee Resources Department @ 715-261-1457