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Forms & publications
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MetLife PEBB life insurance 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.
FormMetLife retiree Certificate of Coverage (COC) non-Washington residents 2019
This is the MetLife retiree life insurance certificate of coverage (COC) for retirees who do not live in Washington.
PublicationMetLife retiree Certificate of Coverage (COC) Washington residents 2019
This is the MetLife retiree life insurance certificate of coverage (COC) for retirees who live in Washington.
PublicationMetLife retiree enrollment/change form
Use this form to enroll in or change enrollment in retiree term life insurance through MetLife.
FormPEBB Certification of a child with disability 2019
50-142-2019After turning 26, your dependent may be eligible for enrollment under your PEBB coverage. Use this form to certify your dependent's disability and enroll them on your PEBB coverage.
FormPEBB Delta Dental (DeltaCare and Uniform Dental Plan) preauthorization requirements
Preauthorization requirements for DeltaCare and Uniform Dental Plan (administered by Delta Dental of Washington). Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.
PublicationPEBB dental 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. For information on specific benefits and exclusions, refer to the dental plan’s certificate of coverage or contact the plan directly.
PublicationPEBB dental benefits comparison 2020
50-706This 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. For information on specific benefits and exclusions, refer to the dental plan’s certificate of coverage or contact the plan directly.
PublicationPEBB Kaiser Permanente NW Classic Summary of Benefits and Coverage (SBC) 2020
A summary of what the PEBB Kaiser Permanente NW Classic plan covers and what it costs.
PublicationPEBB Kaiser Permanente NW Consumer Directed Health Plan (CDHP) Summary of Benefits and Coverage (SBC) 2020
A summary of what the PEBB Kaiser Permanente NW Consumer Directed Health Plan (CDHP) plan covers and what it costs.
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