Forms & publications

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Medical Incident Report

This form is to report to Regence if an injury or illness may be covered under a third party. You may need to use this form even if the incident is not subject to third party coverage.


Retiree coverage change form (form E) 2019


Use Form E to make changes to your PEBB retiree insurance coverage.


Retiree coverage election form (form A) 2019


This is the 2019 Retiree Coverage Election Form (form A). Use this form to elect Retiree insurance coverage. To make changes to your retiree insurance coverage, use the 2019 Retiree Coverage Change Form (form E).