Forms & publications

This is the 2025 October For Your Benefit newsletter for employer groups. Includes the annual notice of creditable prescription drug coverage

This is the October 2025 For Your Benefit newsletter for PEBB Retirees. Includes the annual notice of creditable prescription drug coverage.

This is the 2025 October For Your Benefit newsletter for state agency and higher education employees. Includes the annual notice of creditable prescription drug coverage.

The 2026 Retiree Coverage Election Form (form A-OE). Use this form to make changes during open enrollment (October 27 through November 24, 2025).

This is the 2025 Retiree Coverage Election Form (form A). Use this form to elect PEBB Retiree insurance coverage. To make changes to your retiree insurance coverage, use the 2025 Retiree Coverage Change Form (form E).

2026 PEBB Retiree Election Form (form A). Use Form A to enroll in PEBB retiree coverage.

2026 Medicare Supplement Plan Enrollment form for Plan G. Use Form B to enroll in Medicare Supplemental Plan G, administered by Premera.

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

Use this form to disenroll from Medicare Advantage.

2026 PEBB Medicare Plan Disenrollment Form. Use this form to disenroll from a Medicare Advantage with Part D plan or UMP Classic Medicare with Part D.