PEBB Employee Enrollment Guide 2020

50-100

This guide explains everything about PEBB benefits for public employees.

Publication

PEBB employee request for review/notice of appeal

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

Form

PEBB nondiscrimination statement and language access notice

57-401

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

Publication

PEBB retiree/Continuation Coverage notice of appeal

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

Form

PEBB, SEBB, and UMP language assistance insert (HCA 57-245)

57-245

This document provides language access information (including who to contact for interpreters and translation of printed materials) for public employees (PEBB), school employees (SEBB), and UMP members (in 20 languages).

Publication

Premera (SEBB) preauthorization requirements

Preauthorization requirements for Premera Blue Cross. Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

Publication

Premera High PPO (SEBB) Certificate of Coverage (COC) 2020

This benefits book describes what is covered as a SEBB member under Premera High PPO plan, 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.

Publication

Premera High PPO (SEBB) Summary of Benefits and Coverage (SBC) 2020

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

Publication

Premera Medicare supplement plan G enrollment form (Form B)

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

Form

Premera Peak Care EPO (SEBB) Certificate of Coverage (COC) 2020

This benefits book describes what is covered as a SEBB member under Premera Peak Care EPO plan, 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.

Publication

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