MetLife cancellation of supplemental life and AD&D insurance (SEBB)

Use this form if you are a School employee and you wish to cancel your supplemental life and/or accidental death and dismemberment (AD&D) insurance.

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MetLife cancellation of supplemental life insurance form - PEBB employee 2020

50-911

Use this form to notify MetLife that you wish to cancel your Supplemental Life Insurance and/or Supplemental Accidental Death & Dismemberment (AD&D) Insurance. For employees only: Employee Basic Life Insurance ($35,000) and Employee Basic AD&D Insurance ($5,000) is not affected by this form. It is provided by your employer at no cost to you. You cannot cancel your Employee Supplemental Life Insurance and keep Dependent Life Insurance.

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MetLife employee enrollment/change form (PEBB) 2020

Use this form to enroll in or change enrollment in basic life and AD&D insurance, as well as optional life, and/or AD&D insurance for yourself and your dependents. You may need to complete a statement of health. Return this form to MetLife.

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MetLife enrollment form (SEBB) 2020

Use this enrollment form to enroll in supplemental life and supplemental accidental death & dismemberment insurance.

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MetLife PEBB employee Certificate of Coverage (COC) Washington residents

This is the MetLife life insurance and accidental death and dismemberment certificate of coverage for PEBB employees who live in Washington.

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MetLife PEBB employee life insurance Certificate of Coverage (COC) non-Washington residents

This is the MetLife PEBB employee life and accidental death and dismemberment insurance certificate of coverage for employees who do not reside in Washington.

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MetLife PEBB retiree Certificate of Coverage (COC) non-Washington residents

This is the MetLife PEBB retiree life insurance certificate of coverage (COC) for retirees who do not live in Washington.

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MetLife PEBB retiree life insurance Certificate of Coverage (COC) Washington residents

This is the MetLife PEBB retiree life insurance certificate of coverage (COC) for retirees who live in Washington.

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MetLife retiree enrollment/change form 2020

Use this form to enroll in or change enrollment in retiree term life insurance through MetLife.

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MetLife Vision (SEBB) Certificate of Coverage (COC) non-Washington employees

This benefits book describes what is covered as a SEBB member under MetLife Vision, including vision services and specific services not covered by the plan. Finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays.

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