Forms & publications

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

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

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PEBB Kaiser Permanente WA Consumer Directed Health Plan (CDHP) Summary of Benefits and Coverage (SBC) 2020

A summary of what the PEBB Kaiser Permanente WA Consumer Directed Health Plan (CDHP) plan covers and what it costs.

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

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

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

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

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PEBB 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.

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PEBB medical benefits comparison 2020

50-683

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.

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PEBB Medicare benefits comparison 2020

51-604

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. Call the plans directly for more information on specific benefits, including preauthorization requirements and exclusions. Kaiser Permanente NW and Kaiser Permanente WA offer Medicare Advantage plans, but not in all areas.

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PEBB Premium surcharge attestation help sheet 2019

50-226-2019

This is the 2019 Premium Surcharge Attestation Help Sheet. Use the information on this help sheet to attest on your enrollment form or the Premium Surcharge form whether the premium surcharges for tobacco use or spouse/state-registered domestic partner apply.

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PEBB retiree monthly premiums 2019

These are the Public Employees Benefits Board (PEBB) medical plans offered for retirees in 2019. To the right of each plan are the monthly premiums for an individual employee, employee and spouse,* employee with child(ren), and full family. These premiums do not include the monthly premium surcharges, if applicable to your account.

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PEBB retiree monthly premiums 2020

51-275R

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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