Forms & publications
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How to complete the 2018 Retiree Election/Change form (Form A)
This document helps you complete Form A. These are instructions only. Do not return.Fact sheet
Retiree coverage election form (form A) 201951-403F-2019
Use this form to enroll in PEBB retiree insurance coverage.Form
Retiree coverage election/change (Form A) 201851-403F
This is the form to change Retiree medical coverage. This form is also used to enroll in or defer PEBB Retiree medical coverage.Form