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Forms & publications
Can't find what you need? Visit UMP Forms and publications for more documents.
PEBB Continuation Coverage monthly premiums 2019
2019 monthly premiums for PEBB Continuation Coverage (COBRA and unpaid leave)
PublicationPEBB Initial Notice of COBRA and Continuation Coverage Rights
50-800Booklet that explains your rights to continue PEBB health coverage after it ends.
PublicationPremera Medicare supplement plan F enrollment form (Form B)
Use this form to enroll in Medicare Supplemental insurance administered by Premera.
FormPremium Payment Plan Election/Change Form
50-185Complete this form if you do not want to pay your medical premiums with pretax earnings.
FormPremium surcharge attestation change form 2019
50-563-2019This is the 2019 Premium Surcharge Change form. Use this form to report a change that affects your surcharge for tobacco use and/or spouse or state-registered domestic partner coverage.
FormPremium surcharge help sheet 2019
50-226-2019This is the 2019 Premium Surcharge Help Sheet. Use the information on this help sheet to attest on your enrollment form or the Premium Surcharge form whether the premium surcharges for tobacco use or spouse/state-registered domestic partner apply.
FormPrescription drugs welcome postcard 2019
This postcard briefly introduces you to your prescription drug benefit and tells you where you can find more information.
PublicationPrevious K-12 School Employees Benefits Structure
Paper describing how school employees benefits were managed before SEBB Program for news media.
Fact sheetQuick Start Guide for UMP CDHP 2018
This guide gives a brief overview of the UMP CDHP medical and prescription drug benefits for 2018.
PublicationQuick Start Guide for UMP CDHP 2019
This guide gives a brief overview of the UMP CDHP medical and prescription drug benefits for 2019.
Publication