Forms & publications

These are the 2025 monthly premiums for PEBB Continuation Coverage (Employer Group Ended Participation) members.

Use this form to enroll in or change your enrollment options for PEBB Continuation Coverage (Unpaid Leave).

This is the booklet you will receive when your Public Employees Benefits Board (PEBB) health coverage ends. This booklet explains how you and your dependents can continue your PEBB health coverage. To continue PEBB health coverage, you must complete the enclosed forms and follow the instructions.

These are the monthly premiums for PEBB Continuation Coverage subscribers in 2025. These premiums do not include the monthly premium surcharges, if applicable.

Use this form if you are requesting an appeal of a decision.

This nondiscrimination statement describes how the PEBB Program and its contracted health plans comply with applicable federal civil rights laws.

This benefits book describes what is covered under Premera High PPO, including medical services and prescription drugs, as well as specific services not covered by the plan. Finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays. It also includes how to request an appeal, submit a claim, and how Medicare works with your plan.

A summary of what the SEBB Premera High PPO plan covers and what it costs.

This benefits book describes what is covered under Premera HMO, including medical services and prescription drugs, as well as specific services not covered by the plan. Finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays. It also includes how to request an appeal, submit a claim, and how Medicare works with your plan.

A summary of what the SEBB Premera HMO plan covers and what it costs.