Forms & publications

This is the 2025 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 2025 Retiree Coverage Change Form (form E).

This is the 2025 SEBB Spousal plan calculator form. Use this form if you answered 'YES' to all the questions on your enrollment form and are wanting to enroll a spouse or state-registered domestic partner.

This is the 2025 Spousal plan calculator form. Use this form if you answered 'YES' to all the questions on your enrollment form and are wanting to enroll a spouse or state-registered domestic partner.

This is the 2025 Spousal plan calculator form. Use this form if you answered 'YES' to all the questions on your enrollment form and are wanting to enroll a spouse or state-registered domestic partner.

This is the 2025 SEBB Spousal plan calculator form. Use this form if you answered 'YES' to all the questions on your enrollmetn form and are wanting to enroll a spouse or state-registered domestic partner.