Forms & publications

Can't find what you need? Visit UMP Forms and publications for more documents.

Employee enrollment/change form 2019

50-400-2019

Use this form to enroll in or make changes to PEBB Program benefits for you or your dependents.

Form

Employee monthly premiums 2019

These are the Public Employee Benefits Board (PEBB) Program medical plans offered for 2019. These premiums apply to employees in state agencies, higher-education institutions, and community and technical colleges. These premiums do not include the monthly premium surcharges, if applicable to your account.

Publication

Employee Request for Review/Notice of Appeal form

50-122

Use this form if you are requesting an appeal of a decision.

Form

Extended dependent certification 2019

50-500-2019

Submit this form with your enrollment form if you are enrolling an extended (legal) dependent child.

Form

For Your Benefit (2017-09)

This is the September 2017 For Your Benefit newsletter for all PEBB members.

Newsletter

For Your Benefit (2018-02)

The February 2018 edition of PEBB's For Your Benefit newsletter.

Newsletter

For Your Benefit (2018-09)

September 2018 For Your Benefit newsletter.

Newsletter

For Your Benefit (2019-02)

PEBB Program's For Your Benefit newsletter for February 2019.

Newsletter

For Your Benefit (2019-06)

The PEBB Program's For Your Benefit newsletter is your source for updated information about your PEBB benefits.

Newsletter

For your benefit: Employee (2017-02)

This is the February 2017 For Your Benefit newsletter for state agency and higher-education employees.

Newsletter

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