Forms & publications

This benefits book describes what is covered under Kaiser Permanente WA Options Summit PPO 3, including medical services and prescription drugs, as well as specific services not covered by the plan. Finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays. It also includes how to request an appeal, submit a claim, and how Medicare works with your plan.

A summary of what the SEBB Kaiser Permanente WA Options Summit PPO 3 plan covers and what it costs.

This is the Long-term Disability (LTD) Certificate of Coverage (COC) for Public employees in PEBB benefits. It includes information on eligibility, enrollment, exclusions, and premiums.

This is the Long-term Disability (LTD) Certificate of Coverage (COC) for school employees in SEBB benefits. It includes information on eligibility, enrollment, exclusions, and premiums.

The chart briefly compares the medical deductibles and per-visit out-of-pocket costs of some in-network benefits for PEBB medical plans. Copays and coinsurances may apply; some copays and coinsurance do not apply until after you have paid your annual deductibles. Call the plans for more information on specific benefits, including preauthorization requirements and exclusions. If anything in these charts conflicts with the plan’s benefits book, the benefits book takes precedence.

The chart briefly compares the medical deductibles and per-visit out-of-pocket costs of some in-network benefits for SEBB medical plans. Copays and coinsurances may apply; some copays and coinsurance do not apply until after you have paid your annual deductibles. Call the plans for more information on specific benefits, including preauthorization requirements and exclusions. If anything in these charts conflicts with the plan’s benefits book, the benefits book takes precedence and prevails.

All school employees are offered a selection of plans based on their county of residence or the county where their employment location is. Some school employees may have more plan options if they work in a district that crosses county lines. Be sure to call the medical plans you are interested in to ask about provider availability.

Use this form to disenroll from Medicare Advantage.

This is the MetLife accidental death and dismemberment (AD&D) insurance certificate of coverage (COC) for PEBB employees.

This is the MetLife life insurance certificate of coverage (COC) for PEBB employees