Certification of a Child with a Disability (SEBB) 2021

20-0061

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

Form

Certification of a Child with Disability (PEBB) 2021

50-0142

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