Forms & publications

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PEBB Continuation Coverage (COBRA) election/change form 2019

50-245F-2019

Use this form to enroll in or change your enrollment options for COBRA coverage.

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

Retiree/COBRA/PEBB Continuation Coverage Notice of Appeal

51-122

This form is used by Retirees and PEBB Continuation Coverage subscribers to request an appeal.

Form