Forms & publications

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 consumer-directed health plan (CDHP) with an HSA before you can start a payroll deduction.

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 consumer-directed health plan (CDHP) with an HSA before you can start a payroll deduction.

Guidance on PEBB benefits available to public employees and their dependents. This guide includes information on eligibility, enrollment, dependent verification, benefits (medical, dental, vision coverage, life insurance, long-term disability insurance, flexible spending arrangements, the dependent care assistance program, and SmartHealth wellness program), medical plan premiums, medical plans available, premium surcharges, how to change coverage, and how to file an appeal.

The 2026 PEBB Employee Enrollment/Change form. Use this form to enroll in benefits or make changes to your benefits.

The 2026 PEBB Employee Enrollment/Change form for Medical Only groups. Use this form to enroll in benefits or make changes to your benefits.

These are the PEBB employee premiums for medical plans offered for 2025. These premiums apply to employees in state agencies, higher-education institutions, and community and technical colleges. These premiums do not include the monthly premium surcharges, if applicable.

These premiums apply to employees in state agencies, higher-education institutions, and community and technical colleges. These premiums do not include the monthly premium surcharges, if applicable to your account.

This publication lists the monthly medical premiums for school employees in 2025.

The monthly medical premiums for school employees in 2026.

Fact sheet about the PEBB and SEBB Programs for the Legislature.