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)

Publication

PEBB Initial Notice of COBRA and Continuation Coverage Rights

50-800

Booklet that explains your rights to continue PEBB health coverage after it ends.

Publication

Premera Medicare supplement plan F enrollment form (Form B)

Use this form to enroll in Medicare Supplemental insurance administered by Premera.

Form

Premium Payment Plan Election/Change Form

50-185

Complete this form if you do not want to pay your medical premiums with pretax earnings.

Form

Premium surcharge attestation change form 2019

50-563-2019

This 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.

Form

Premium surcharge help sheet 2019

50-226-2019

This 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.

Form

Prescription drugs welcome postcard 2019

This postcard briefly introduces you to your prescription drug benefit and tells you where you can find more information.

Publication

Previous K-12 School Employees Benefits Structure

Paper describing how school employees benefits were managed before SEBB Program for news media.

Fact sheet

Quick Start Guide for UMP CDHP 2018

This guide gives a brief overview of the UMP CDHP medical and prescription drug benefits for 2018.

Publication

Quick Start Guide for UMP CDHP 2019

This guide gives a brief overview of the UMP CDHP medical and prescription drug benefits for 2019.

Publication

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