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SEBB Continuation Coverage (Unpaid Leave) Election/Change form 2023

Use this form to enroll in or change your enrollment options for SEBB Continuation Coverage (Unpaid Leave) coverage.

20-0059
Form

Free or low-cost health care
- I need medical, dental, or vision care
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  - Other Apple Health programs
  - Am I eligible?
  - Learn about my coverage
  - Use my coverage
  - Manage my coverage
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  - Prenatal, children & young adults
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- Quick links
- Contact Apple Health (Medicaid)
- News
Employee & retiree benefits
- Public employees
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- School employees
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- Retirees
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  - Learn how to enroll
  - Learn how & why to defer
  - For survivors
  - Manage benefits
  - Get help
- PEBB Continuation Coverage
  - Find benefits
  - Explore costs
  - Determine eligibility
  - Learn how to enroll
    - For newly eligible members
    - Verify & enroll my dependents
  - For survivors
  - Manage benefits
  - Get help
- SEBB Continuation Coverage
  - Find benefits
  - Explore costs
  - Determine eligibility
  - Learn how to enroll
    - For newly eligible members
    - Verify & enroll my dependents
  - For survivors
  - Manage benefits
  - Get help
- Quick links
- Contact us
- PEBB news
- SEBB news
Billers, providers & partners
- Prior authorization, claims & billing
  - Getting started
  - Submit prior authorization (PA)
    - Step-by-step guide for prior authorization (PA)
    - Pharmacy prior authorization
  - Submit claims
    - Provider billing guides & fee schedules
    - Hospital rates & reimbursement
- Program information for providers
- Become an Apple Health provider
  - Learn how to enroll
  - What's next
    - Find next steps for new Medicaid providers
  - For existing medicaid providers
    - Update my provider information
    - Revalidation
- Learn ProviderOne
  - Getting started
    - How do I access ProviderOne?
  - Training materials
- Quick links
- Contact us
- News
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- Who we are
  - About us
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- Other administrative activities
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