How do I enroll?

Whether you’re newly eligible or enrolling after deferring coverage, the most important thing you need to do is submit the Retiree Election Form (form A) — along with any other required forms and documents based on your situation — by the required deadline. Once you have submitted your enrollment materials we will notify you of next steps.

Need help completing the Retiree Election Form (form A)?

About to retire? There is a limited time to enroll.

If you are about to retire, you have 60 days after your current coverage ends to submit an enrollment form to the PEBB Program showing that you want to enroll in PEBB retiree insurance coverage. 

"Current coverage" includes: 

  • Employer-paid coverage (for example, a state agency or public school)
  • COBRA coverage
  • Continuation coverage

Understand the deadlines

The deadlines listed on this page indicate when the PEBB Program must receive all required forms and supporting documentation. This is not a postmark date. If we do not receive your materials by the required deadline, you may lose your opportunity to enroll.

(Retiree eligibility and enrollment timelines are extended due to COVID-19 through an emergency resolution.)

Things you must do and their deadlines

First, you must submit the Retiree Election Form (form A) to the PEBB Program. After that, what you do depends on your situation. 

Enroll or defer now to protect your eligibility. If you do not enroll in PEBB retiree insurance coverage when you first become eligible, you are only eligible to enroll at a later date if you deferred enrollment when you were first eligible and maintained continuous enrollment in other qualified medical coverage.

For eligible retiring or separating employees

What do I do? 

You must submit the following materials to the PEBB Program: 

  • Retiree Election Form (form A)
  • Any other required forms or documents, based on your situation
  • Your first premium payment (by check or pension deduction)
  • Premiums and applicable premium surcharges back to the date your other coverage ended, if applicable

Eligible for Medicare? If you or a dependent are eligible for Medicare, the eligible person must enroll (and stay enrolled) in Medicare Part A and Part B. 

By when?

Forms and documentation: No later than 60 days after your employer-paid, COBRA, or continuation coverage ends.

First premium payment: No later than 45 days after the 60-day period above. You will not be enrolled until we receive payment.

For Medicare Advantage: If you select a Medicare Advantage plan, we must receive Form A and Medicare Advantage Plan Election Form (form C) no later than the last day of the month before the month your employer-paid, COBRA, or continuation coverage ends. Otherwise, you may not select these plans until a special open enrollment.

When does coverage begin?

If you are eligible to enroll and submit your documents and payment by the deadlines, your coverage will begin the first day of the month after your employer-paid, COBRA, or continuation coverage ends.

For elected or full-time appointed officials leaving public office

What do I do? 

You must submit the following materials to the PEBB Program: 

  • Retiree Election Form (form A)
  • Any other required forms or documents, based on your situation
  • Your first premium payment (by check or pension deduction)
  • Premiums and applicable premium surcharges back to the date your other coverage ended, if applicable

Eligible for Medicare? If you or a dependent are eligible for Medicare, the eligible person must enroll (and stay enrolled) in Medicare Part A and Part B. 

By when?

Forms and documentation: No later than 60 days after you leave public office.

First premium payment: No later than 45 days after the 60-day period above. You will not be enrolled until we receive payment.

For Medicare Advantage: If you select a Medicare Advantage plan, we must receive Form A and the Medicare Advantage Plan Election Form (form C) either:

  • Before you leave public office, or
  • No later than the last day of the month before the month your PEBB coverage ends.

Otherwise, you may not select these plans until a special open enrollment.

When does coverage begin?

If you are eligible to enroll and submit your documents and payment by the deadlines, your coverage will begin the first day of the month after your employer-paid, COBRA, or continuation coverage ends.

For surviving dependents

If you are a survivor, or a dependent becoming eligible as a survivor, and are ready to enroll, visit Enroll as a survivor.

If you have questions about eligibility, visit Are my survivors eligible?

For employees eligible for disability retirement

You must be approved by the Department of Retirement Systems (DRS) or the appropriate higher-education authority for disability retirement before you enroll.

What do I do? 

You must submit the following materials to the PEBB Program: 

  • Retiree Election Form (form A). Include on your form if you want coverage to begin starting from your retirement date or the first of the month after your formal determination of disability retirement eligibility.
  • Any other required forms or documents, based on your situation
  • Your first premium payment (by check or pension deduction)
  • Premiums and applicable premium surcharges back to the date your other coverage ended, if applicable

Eligible for Medicare? If you or a dependent are eligible for Medicare, the eligible person must enroll (and stay enrolled) in Medicare Part A and Part B. 

By when?

Forms and documentation: No later than 60 days after the date of the Washington State-sponsored retirement systems formal determination letter.

First premium payment: No later than 45 days after the 60-day period above. You will not be enrolled until we receive payment.

For Medicare Advantage: If you select a Medicare Advantage plan, we must receive Form A and Medicare Advantage Plan Election Form (form C) no later than the last day of the month before the month your employer-paid, COBRA, or continuation coverage ends. Otherwise, you may not select these plans until a special open enrollment.

When does coverage begin?

If you are eligible to enroll and submit your documents and payment by the deadlines, your coverage will begin as you request on your enrollment form. Either: 

  • Your disability retirement date, or
  • The first day of the month after the date the formal determination letter was written.

Criteria you must meet

This is the criteria you must meet to be eligible to enroll in PEBB retiree insurance coverage.

You must be a vested member and meet the eligibility criteria to retire from a Washington State-sponsored retirement plan when your employer, COBRA, or continuation coverage ends

Washington State-sponsored retirement plans include:

  • Public Employees' Retirement System (PERS) 1, 2, or 3
  • Public Safety Employees' Retirement System (PSERS) 2
  • Teachers Retirement System (TRS) 1, 2, or 3
  • Washington Higher Education Retirement Plan (HERP) (for example, TIAA-CREF)
  • School Employees' Retirement System (SERS) 2 and 3
  • Law Enforcement Officers' and Fire Fighters' Retirement System (LEOFF) 1 or 2
  • Washington State Patrol Retirement System (WSPRS) 1 or 2
  • State Judges/Judicial Retirement System
  • Civil Service Retirement System and Federal Employees' Retirement System (for Washington State University Extension employees covered under PEBB benefits at the time of retirement).

Different rules apply if you are an elected or full-time appointed official or an employee of an employer group that does not participate in a Washington State-sponsored retirement plan. (Refer to Related laws and rules.)

You must immediately begin to receive a monthly retirement plan payment, unless one of the following exceptions apply
  • If you receive a lump sum payment, you are only eligible for PEBB retiree insurance coverage if DRS offered you the choice between a lump sum actuarially equivalent payment and an ongoing payment. 
  • If you are an employee retiring or separating under PERS Plan 3, TRS Plan 3, or SERS Plan 3, and you meet the plan's eligibility criteria.
  • If you are an employee retiring under a Washington State Higher Education Retirement Plan (such as TIAA-CREF) and meet your plan's retirement eligibility criteria or you are at least age 55 with 10 years of state service. 
  • If you are a retiring employee from a PEBB employer group who is eligible to retire under a retirement plan sponsored by an employer group or tribal government, and your employer does not participate in a Washington State-sponsored retirement plan. However, you must meet the same age and years of service requirements as if they had been employed as a member of PERS Plan 1 (if your date of hire with your employer group was before October 1, 1977) or Plan 2(if your date of hire was on or after October 1, 1977).
  • If you are an elected or a full-time appointed official of the legislative or executive branch of state government, you do not have to meet the age and years of service requirements or receive a monthly retirement plan payment from a Washington State-sponsored retirement plan.
  • If you are an elected or full-time appointed official of the executive branch, or a surviving dependent of such an official, you do not have to meet the age and years of service requirements or receive a monthly retirement plan payment from a Washington State-sponsored retirement plan.
  • If you are a survivor of an emergency service person killed in the line of duty, or a surviving dependent who loses eligibility because of the death of an eligible retiree, you do not have to meet the age and years of service requirements or receive a monthly retirement plan payment from a Washington State-sponsored retirement plan.

Find your forms

The forms are labeled with letters in the upper right corner to help you identify them. You will often need to submit more than one form. Whether you are enrolling in coverage for the first time or after deferring coverage, the most important form you must complete and submit is Retiree Election Form (form A)

Depending on which plan you choose, you may need one or more of these retiree forms: 

  • Form A – For enrolling in coverage when first eligible
  • Form B – For enrolling in Premera Blue Cross Medicare Supplement Plan G
  • Form C – For enrolling in a Medicare Advantage plan
I need Form A to enroll in...

For the following medical plans, you only need the Retiree Election Form (form A).

  • Kaiser Permanente NW: Classic or CDHP
  • Kaiser Permanente WA: Classic, CDHP, Original Medicare, SoundChoice, or Value
  • Uniform Medical Plan (UMP): Classic, Select, or CDHP
  • UMP Plus–Puget Sound High Value Network (PSHVN) or UMP Plus–UW Medicine Accountable Care Network (ACN)
I need both Forms A and C to enroll in...

For the following medical plans, you need both Retiree Election Form (form A) and Medicare Advantage Plan Election Form (form C).

  • Kaiser Permanente NW Senior Advantage
  • Kaiser Permanente WA Medicare Advantage
  • UnitedHealthcare: PEBB Balance or PEBB Complete
I need both Forms A and B to enroll in...

For Premera Blue Cross Medicare Supplement Plan G, you need both Retiree Election Form (form A) and Premera Medicare Supplement Plan G Enrollment Form (form B).

Additional forms and documentation

Depending on your situation, you may need to submit additional forms or documentation.

To enroll a dependent

You need to submit documents that prove your dependent's eligibility (unless you are enrolled in Medicare Part A and Part B). You may also need to submit additional forms for certain dependents.

Visit Verify and enroll dependents to view a list of valid verification documents based on the type of dependent (i.e., spouse, child, etc.).

If you or your dependents are enrolled in Medicare

You will need to submit photocopies of Medicare cards for you or any covered dependents. Write your full name and the last four digits of your Social Security number on the copy. 

Submit your materials

Reminder: The PEBB Program must receive your forms, documentation, and payment by the enrollment period deadlines.

Where do I submit my materials?

Forms and documentation

Submit your forms and documentation using one of the following methods.

Electronically

Submit your forms through HCA Support. Attach them to a secure message. Be sure to sign them (typed signatures are not allowed). This option is separate from PEBB My Account.

To keep your personal information secure, you will need to register for an account (if you don't already have one) to submit your materials using this method.

By mail

Washington State Health Care Authority
PEBB Program
PO Box 42684
Olympia, WA 98504-2684

By fax

360-725-0771

First payment and premium surcharges

If you're sending payment with your forms, enclose your check or money order payable to Health Care Authority and mail to:

Washington State Health Care Authority
PO Box 42691
Olympia, WA 98504-2691

How do I pay my premiums?

You have three options to pay for coverage, which are described on Form A:

  • Pension deduction
  • Monthly invoice
  • Electronic Debit Service (EDS)

For details on payment options, visit Paying for benefits.

What happens after I submit?

After you submit your enrollment materials, we will process them and send you a letter notifying you of next steps. 

Your employer is responsible for cancelling your employee coverage. In some cases, we cannot enroll you in PEBB retiree insurance coverage until this occurs. 

Related laws and rules

Washington Administrative Codes (WACs) are the official rules used for PEBB Program eligibility and enrollment.

For employees
  • WAC 182-12-171: When is a retiring employee or a retiring school employee eligible to enroll in public employees benefits board (PEBB) retiree insurance coverage?
  • WAC 182-12-211: May an employee or a school employee who is determined to be retroactively eligible for disability retirement enroll or defer enrollment in public employees benefits board (PEBB) retiree insurance coverage?
For elected or full-time appointed officials
  • WAC 182-12-180: When is an elected and full-time appointed official of the legislative and executive branch of state government, or their survivor eligible to continue enrollment in public employees benefits board (PEBB) retiree insurance coverage?