PEBB Continuation Coverage Election/Change form (COBRA) 2021

50-0136

Use this form to enroll in or change your enrollment options for COBRA coverage. Due to the COVID-19 pandemic, the PEBB Program has temporarily changed the deadline to enroll in PEBB Continuation Coverage. If you are already enrolled, you may be able to keep PEBB Continuation Coverage longer than normal. To learn more about these exceptions to the timelines listed in this document, visit HCA's website at hca.wa.gov/coronavirus.

Form

PEBB Continuation Coverage Election/Change form (Unpaid Leave) 2021

50-0135

Use this form to enroll in or change your enrollment options for PEBB Continuation Coverage (Unpaid Leave). Due to the COVID-19 pandemic, the PEBB Program has temporarily changed the deadline to enroll in PEBB Continuation Coverage. If you are already enrolled, you may be able to keep PEBB Continuation Coverage longer than normal. To learn more about these exceptions to the timelines listed in this document, visit HCA's website at hca.wa.gov/coronavirus.

Form