See forms for:

 

  

Employee forms

Enrollment/changes

Flexible spending arrangement (FSA) and Dependent Care Assistance Program (DCAP)

Health savings account (HSA) 

Life and accidental death and dismemberment (AD&D) insurance

Note: Life insurance portability forms are available through your employer.

Long-term disability (LTD)

   

Retiree forms 

Enrollment/changes

Health savings account (HSA)

Life insurance

  

Continuation of coverage forms

For COBRA, Leave Without Pay (LWOP), and PEBB Extension of Coverage

Enrollment/changes

 

Dependent certification forms

For enrolling a registered domestic partner, a domestic partner's child, a dependent child with a disability, or an extended legal dependent child. 

Enrollment/changes

   

Attestation forms

For attestations/changes​​​

 


Privacy and appeals

Privacy

Appeals