Forms & publications

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Continuation coverage election/change form (for Leave Without Pay) 2018

50-135F-2018

Use this form to enroll in or change your enrollment options for continuation coverage (LWOP).

Form

PEBB Continuation Coverage (Unpaid Leave) election/change form 2019

50-135F-2019

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

Form