Kaiser Permanente WA SoundChoice (PEBB) Summary of Benefits and Coverage (SBC) 2020

A summary of what the PEBB Kaiser Permanente WA SoundChoice plan covers and what it costs.

Publication

Kaiser Permanente WA Value (PEBB employees) Certificate of Coverage (COC) 2020

This benefits book describes what is covered under Kaiser Permanente WA Value, including medical services and prescription drugs, as well as specific services not covered by the plan. Finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays. It also includes how to request an appeal, submit a claim, and how Medicare works with your plan.

Publication

Kaiser Permanente WA Value (PEBB) Summary of Benefits and Coverage (SBC) 2020

A summary of what the PEBB Kaiser Permanente WA Value plan covers and what it costs.

Publication

Kaiser Permanente WA Value Certificate of Coverage (COC) 2019

This benefits book describes what is covered under Kaiser Permanente WA Value, including medical services and prescription drugs, as well as specific services not covered by the plan. Finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays. It also includes how to request an appeal, submit a claim, and how Medicare works with your plan.

Publication

Kaiser Permanente WA Value Summary of Benefits and Coverage (SBC) 2019

A summary of what the Kaiser Permanente WA Value plan covers and what it costs.

Publication

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

MetLife cancellation of supplemental life insurance form - PEBB employee 2019

Use this form to notify MetLife that you wish to cancel your Supplemental Life Insurance and/or Supplemental 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 Supplemental Life Insurance and keep Dependent Life Insurance.

Form

MetLife cancellation of supplemental life insurance form - PEBB employee 2020

50-911

Use this form to notify MetLife that you wish to cancel your Supplemental Life Insurance and/or Supplemental 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 Supplemental Life Insurance and keep Dependent Life Insurance.

Form

MetLife employee enrollment/change form (PEBB) 2020

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 employee enrollment/change form 2019

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

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