Forms & publications

Retiree Election Form (form A) 2022

This is the 2022 Retiree Election Form (form A). Use this form to elect PEBB Retiree insurance coverage. To make changes to your retiree insurance coverage, use the 2022 Retiree Coverage Change Form (form E).

Retiree Enrollment Form (form A) 2023

This is the 2023 Retiree Coverage Election Form (form A). Use this form to elect PEBB Retiree insurance coverage. To make changes to your retiree insurance coverage, use the 2023 Retiree Coverage Change Form (form E).