ers banner

Supplemental Information

The ERS Supplemental Information form is used to designate a primary care physician (PCP). Please note, they are NOT enrollment forms and do NOT verify eligibility.

There are two forms: one for employees and the other for retirees. PLEASE BE SURE TO READ THE INSTRUCTIONS ON THE BACK OF THE FORM BEFORE COMPLETING.

Supplemental Information Form - Active Employees

Supplemental Information Form - Retirees

ers logo