Forms & publications

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Certification of a child with disability 2019

50-142-2019

After 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.

Form

Certification of dependent with a disability 2018

50-142-2018

After turning 26, your dependent may be eligible for enrollment under your PEBB medical. Use this form to certify your dependent's disability and enroll them on your PEBB medical.

Form