Forms & publications

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

Long-Term Disability (LTD) Program Certificate of Coverage (COC) 2019

This is the Long-term Disability (LTD) Program book. It includes information on eligibility, enrollment, exclusions, and premiums.

Publication

Medical benefits comparison 2019

This chart briefly compares the per-visit costs of some in-network benefits for PEBB plans. Some copays and coinsurance do not apply until after you have paid your annual deductible.

Publication

Medical Claim Form

This form is for sending in a claim for medical services for all Uniform Medical Plans.

Form

MetLife beneficiary designation

Use this form to name the persons or entities you want to receive your life insurance proceeds after your death. Return this form to MetLife.

Form

MetLife cancellation of optional life insurance form - employee

Use this form to notify MetLife that you wish to cancel your Optional Life Insurance and/or Optional Accidental Death & Dismemberment (AD&D) Insurance. For employees only: Employee Basic Life Insurance ($35,000) and Employee Basic AD&D Insurance ($5,000) is not affected by this form. It is provided by your employer at no cost to you. You cannot cancel your Employee Optional Life Insurance and keep Dependent Life Insurance.

Form

MetLife employee enrollment/change form

Use this form to enroll in or change enrollment in basic life and AD&D insurance, as well as optional life, and/or AD&D insurance for yourself and your dependents. You may need to complete a statement of health. Return this form to MetLife.

Form

MetLife employees Certificate of Coverage (COC) non-Washington residents 2019

MetLife employee Certificate of Coverage (COC) Washington residents 2019.

Publication

MetLife employees Certificate of Coverage (COC) Washington residents 2019

MetLife employee Certificate of Coverage (COC) Washington residents 2019.

Publication

Paying for your premiums with pretax dollars

50-580

This is a FAQ document about pretax deductions for your PEBB medical plan. If you are an eligible state agency or higher-education institution employee enrolling in a PEBB medical plan, your employer may deduct your medical premium from your paycheck before calculating federal withholding, Social Security, and Medicare taxes.

Publication

Premium Payment Plan Election/Change Form

50-185

Complete this form if you do not want to pay your medical premiums with pretax earnings.

Form

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