Forms & publications

Preauthorization requirements for UMP plans (administered by Regence). This document includes: Substance use disorder, mental health, DME, surgery and transplants. 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.

Preauthorization requirements for UMP plans (administered by Regence). 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.

This nondiscrimination notice describes how Regence complies with applicable federal and Washington State civil rights laws. It also provides information about language assistance.

Use Form E to make changes to your PEBB retiree insurance coverage.

This is the 2024 Retiree Coverage Election Form (form A). Use this form to enroll in PEBB Retiree insurance coverage. To make changes to your retiree insurance coverage, use the 2024 Retiree Coverage Change Form (form E).

This is the 2024 Retiree Enrollment Guide. It contains information you need about enrollment, eligibility, benefits, monthly premiums, and the plans available to retirees.

These are the PEBB retiree premiums for retirees in 2024. These premiums do not include the monthly premium surcharges, if applicable to your account.

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

School board members use this form to enroll in your SEBB insurance coverage.

Use this form to have your employer withhold money from your paychecks and deposit it into your health savings account (HSA) on a pretax basis. Check with your payroll department before submitting this form; not all employers can arrange for payroll deductions. You must be enrolled in a high deductible health plan with an HSA before you can start a payroll deduction.