As of Wednesday, March 18, HCA’s lobby is closed. In-person customer services for Apple Health and the PEBB and SEBB Programs will not be available. Learn more.
How to enroll
Find the required forms and timelines to enroll in PEBB benefits.
On this page
Note: University of Washington employees must enroll through Workday.
To enroll in PEBB benefits you must complete the required forms as indicated below.
The following forms must be received by your personnel, payroll, or benefits office within the timeline listed:
- PEBB Employee Enrollment/Change form (if your employer offers the full benefits package) or PEBB Employee Enrollment/Change for Medical Only Groups form (if your employer offers PEBB medical coverage only): No later than 31 days after you become eligible for PEBB benefits.
- PEBB Long-Term Disability Enrollment/Change form: No later than 31 days after you become eligible for PEBB benefits.
The following form must be received by MetLife:
- PEBB MetLife Enrollment/Change form: No later than 31 days after you become eligible for PEBB benefits.
Generally, you become eligible your first day of employment. Ask your personnel, payroll, or benefits office when your eligibility begins.
Note: You may elect to enroll in supplemental life and AD&D insurance and supplemental long-term disability insurance at any time during the calendar year by submitting the required forms to the contracted vendor. The contracted vendor must approve your request and evidence of insurability will be required.
If you are requesting to enroll dependents, the PEBB Program must receive proof of their eligibility no later than 31 days after you become eligible or the dependents will not be enrolled. See How do I enroll my dependents?
If your personnel, payroll, or benefits office, or MetLife in the case of life insurance, doesn’t receive your completed form(s) and dependent verification documents (if applicable) within the timelines above, you will be enrolled as a single subscriber in Uniform Medical Plan (UMP) Classic, and (if your employer offers these coverages) Uniform Dental Plan (UDP), basic life insurance, and basic long-term disability (LTD) insurance. Your dependents (if any) will not be enrolled and you will be charged a tobacco use premium surcharge. You will owe medical premiums and the tobacco use premium surcharge back to the date your insurance coverage began.You cannot change plans or enroll eligible dependents until the next PEBB Program annual open enrollment (November 1 through 30), unless you have a special open enrollment event that allows the change.
If you enroll dependents on your PEBB coverage, you must provide proof of their eligibility within the required enrollment timelines or the dependents will not be enrolled. See Dependent verification. You may also need these forms:
- PEBB Declaration of Tax Status - To enroll a state-registered domestic partner or a state-registered domestic partner's child, extended dependent, or nonqualified tax dependent.
- PEBB Certification of a Child with a Disability - To enroll a dependent child with a disability (age 26 and over)
- PEBB Extended Dependent Certification - To enroll an extended (legal) dependent child
An individual may be enrolled in only one PEBB medical or dental plan. If you and your spouse or state-registered domestic partner are both eligible for PEBB coverage, you need to decide which of you will cover yourselves and any eligible children on your medical or dental plans. For example, you could waive medical coverage for yourself and enroll as a dependent on your spouse’s, state-registered domestic partner’s, or parent’s medical coverage. However, you must enroll in PEBB dental, basic life, basic AD&D insurance, and basic LTD insurance under your own account. See Waiving medical coverage.
You may waive enrollment in PEBB medical if you are enrolled in other employer-based group medical, a TRICARE plan, or Medicare. You must submit a form to waive enrollment in PEBB medical. If you waive coverage for yourself, you cannot enroll your eligible dependents in PEBB medical. See Waiving medical coverage.
When does coverage start?
If you're newly eligible
Medical, dental, basic life, basic AD&D insurance, and basic LTD insurance coverage begins on the first day of the month following the date you become eligible for PEBB benefits (generally the first day of employment). If you become eligible on the first working day of the month, benefits begin on that day.
If you're a faculty member hired on a quarter/semester to quarter/semester basis
Medical, dental, basic life, basic AD&D insurance, and basic LTD insurance begins on the first of the month following the beginning of the second consecutive quarter/semester of halftime or more employment (or anticipated half-time or more employment). If the first day of the second consecutive quarter/semester is the first working day of the month, benefits begin at the beginning of the second consecutive quarter/semester.
How do I get my plan ID card(s)?
After you enroll, your health plan(s) will send you an identification (ID) card to show providers when you receive care. If you have questions about your ID card, contact your plan directly. The Uniform Dental Plan does not mail ID cards, but you may download one from the plan’s website.
What if I want to change my coverage later?
You can change plans or make enrollment changes at the next PEBB Program annual open enrollment or if you have a special open enrollment event that allows the change.