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Forms & publications
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Certification of a child with disability 2019
50-142-2019After turning 26, your dependent may be eligible for enrollment under your PEBB coverage. Use this form to certify your dependent's disability and enroll them on your PEBB coverage.
FormExtended dependent certification 2019
50-500-2019Submit this form with your enrollment form if you are enrolling an extended (legal) dependent child.
Form