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

Premium Payment Plan Election/Change Form

50-185

Complete this form if you do not want to pay your medical premiums with pretax earnings.

Form