Forms & publications

Premium Surcharge Attestation Change form (PEBB) 2025

This is the 2025 PEBB Premium Surcharge Attestation 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.

Premium Surcharge Attestation Change form (PEBB) 2026

The 2026 PEBB Premium Surcharge Attestation 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.

Premium Surcharge Attestation Change form (SEBB) 2025

This is the 2025 SEBB Premium Surcharge Attestation 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.

Premium Surcharge Attestation Change form (SEBB) 2026

The 2026 SEBB Premium Surcharge Attestation 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.

Retiree Enrollment Guide 2025

This is the 2025 Retiree Enrollment Guide. It contains information you need about enrollment, eligibility, benefits, monthly premiums, and the plans available to retirees.