Retiree coverage election form (form A) 2020

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This is the 2020 Retiree Coverage Election Form (form A). Use this form to elect Retiree insurance coverage. To make changes to your retiree insurance coverage, use the 2020 Retiree Coverage Change Form (form E).

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Retiree enrollment guide 2020

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This is the 2020 PEBB retiree enrollment guide. It contains information you need about enrollment, eligibility, benefits, monthly premiums, and the plans available to retirees

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Retiree monthly premiums (PEBB) 2020

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These are the Public Employees Benefits Board (PEBB) medical plans offered for retirees in 2020. To the right of each plan are the monthly premiums for an individual subscriber, subscriber and spouse,* subscriber with child(ren), and subscriber, spouse*, and child(ren). These premiums do not include the monthly premium surcharges, if applicable to your account.

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SmartHealth FAQs

FAQs about SmartHealth including how to join activities and how to sync your device.

Fact sheet

SmartHealth Reasonable Alternative Standard FAQs

For members deemed eligible for Reasonable Alternative Standard, the SmartHealth team will create a program tailored to meet the unique needs and abilities of approved subscribers. After completing the reasonable alternative program, you will earn 2,000 points. In order to qualify for SmartHealth incentives, reasonable alternative participants must meet all program requirements, including completing the Well-being Assessment.

Fact sheet

Spousal plan calculator form (PEBB) 2020

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This is the 2020 Spousal plan calculator form. Use this form if you answered 'YES' to all the questions in the 2020 Premium Surcharge Attestation Help Sheet and are wanting to enroll a spouse or state-registered domestic partner.

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Spousal plan calculator tool (PEBB) 2020 (xls)

This is the 2020 spousal plan calculator. Use this interactive calculator tool to determine if the spousal premium surcharge applies to you if you answered 'YES' to all the questions in the Premium Surcharge Attestation Help Sheet and are wanting to enroll a spouse or state-registered domestic partner on your PEBB medical.

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Summary of Benefits and Coverage 2018 UMP Classic (Medicare)

This document puts your health plan benefits for UMP Classic (Medicare) in a standardized format to help you compare different plans. It includes common services, deductibles, normal cost shares such as copays, coinsurance, and out-of-pocket limits. It also tells you about limits to specific benefits, like a visit or dollar limit for certain services.

Publication

Summary of Benefits and Coverage 2018 UMP Classic (Non-Medicare)

This document puts your health plan benefits for UMP Classic (Non-Medicare) in a standardized format to help you compare different plans. It includes common services, deductibles, normal cost shares such as copays, coinsurance, and out-of-pocket limits. It also tells you about limits to specific benefits, like a visit or dollar limit for certain services.

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Summary of Benefits and Coverage 2018 UMP Consumer-Directed Health Plan (UMP CDHP)

This document puts your health plan benefits for UMP CDHP in a standardized format to help you compare different plans. It includes common services, deductibles, normal cost shares such as coinsurance and out-of-pocket limits. It also tells you about limits to specific benefits, like a visit or dollar limit for certain services.

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