Forms & publications

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Employee enrollment/change for medical groups only 2019

52-030-2019

Use this form to enroll in or make changes to PEBB Program benefits for you and your dependents if your employer offers PEBB Program medical coverage only.

Form

Employee enrollment/change form 2019

50-400-2019

Use this form to enroll in or make changes to PEBB Program benefits for you or your dependents.

Form

MetLife employee enrollment/change form

Use this form to enroll in or change enrollment in basic life and AD&D insurance, as well as optional life, and/or AD&D insurance for yourself and your dependents. You may need to complete a statement of health. Return this form to MetLife.

Form