Forms & publications

This nondiscrimination notice describes how Regence complies with applicable federal and Washington State civil rights laws. It also provides information about language assistance.

Use Form E to make changes to your PEBB retiree insurance coverage.

This is the 2024 Retiree Coverage Election Form (form A). Use this form to enroll in PEBB Retiree insurance coverage. To make changes to your retiree insurance coverage, use the 2024 Retiree Coverage Change Form (form E).

This is the 2024 Retiree Enrollment Guide. It contains information you need about enrollment, eligibility, benefits, monthly premiums, and the plans available to retirees.

These are the PEBB retiree premiums for retirees in 2024. These premiums do not include the monthly premium surcharges, if applicable to your account.

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

This is the 2024 Spousal plan calculator form. Use this form if you answered 'YES' to all the questions on your enrollment form and are enrolling a spouse or state-registered domestic partner.

This is the 2024 Spousal plan calculator form. Use this form if you answered 'YES' to all the questions on your enrollment form and are enrolling a spouse or state-registered domestic partner.

Retirement questions for individuals thinking about retirement.

Members can use this form when purchasing specialty drugs through Ardon Health to request that Ardon Health not use child-resistant caps ("safety caps") to package a member's medication. Ardon Health is a member of Washington State Rx Services (WSRxS)