Forms and publications

Access manuals, forms, enrollment guides, and other resources to support benefits administrators (BAs) with the administration of Public Employees Benefits Board (PEBB) benefits. 

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Below you will find manuals, user guides, and resources related to the PAY1 insurance system, the Benefits 24/7 online enrollment system, accounting, correcting employer errors, appeals, and HCA Support. Employee enrollment resources, such as guides and forms, certification forms for dependents, and many other resources are also available to download.

When printing forms to share with employees, also provide the PEBB nondiscrimination statement and language access notice.

PAY1 insurance system

PAY1 manuals and resources

The following resources are for benefits administrators (BAs).

For employer groups who do not enter enrollment in PAY1: 

These resources can also be found on the PAY1 insurance system webpage.

Benefits 24/7

Benefits 24/7 manuals and resources

The Benefits 24/7 online enrollment system will not be available until launch, which is anticipated to occur in January 2024. However, the Benefits 24/7 training environment is currently available.

The following resources are for benefits administrators (BAs).

Benefits 24/7 training environment: 

For employer groups who do not enter enrollment in the insurance system:

Learn more on the Administering PEBB in Benefits 24/7 webpage.

Accounting

Accounting manuals and resources

The accounting manuals contain the current year's invoicing dates along with other accounting-related guidance. The accounting manual for state agencies also contains the state share cutoff dates. 

These resources can also be found on the Accounting webpage.

Correcting PEBB employer errors

Correction resources for state agencies and institutions of higher education
Correction resources for employer groups

Appeals

Appeals resources for state agencies and institutions of higher education

Learn more on the Appeals process webpage.

Appeals resources for employer groups

HCA Support

HCA Support is a secure, web-based correspondence program that allows you to send documents and communicate directly with O&T, PEBB Accounting, and other departments within the PEBB Program by using the ​​​​designated tile named, "Benefits administrator inquiry".

HCA Support resources

It's important that BAs use the designated tile named, "Benefits administrator inquiry". Using the "General Support" tile will lead to a delayed response, as your inquiry will be initially routed to units at HCA that are outside of O&T.

Employees and dependents

Enrollment guide, forms, and resources

Learn more on the Newly eligible employees webpage.

Dependent forms and resources

Learn more on the Dependents webpage.

Premium surcharges
  • Premium Surcharge Help Sheet 2023 (Help Sheet information for 2024 can be found in the 2024 Premium Surcharge Attestation Change form.)
  • Premium Surcharge Change form 2023 | 2024
  • Spousal Plan Calculator (print version) 2023 | 2024
  • Spousal Plan Calculator tool (interactive tool) 2023 | 2024

Additional premium surcharge resources

Learn more on the Premium surcharges webpage.

Life and accidental death and dismemberment (AD&D) insurance

Life and AD&D forms and resources

Learn more on the Life and AD&D webpage.

Long-term disability (LTD) insurance

LTD forms and resources

Learn more on the LTD webpage.

Flexible Spending Arrangements (FSAs) and Dependent Care Assistance Program (DCAP)

FSA and DCAP forms and resources

For employees of state agencies and higher education institutions only.

Learn more on the FSA and DCAP webpage.

Additional forms and resources

Apple Health (Medicaid)
Dual enrollment

Learn more on the Newly eligible employees webpage.

Health Savings Account (HSA)

Learn more on the Medical plans with health savings accounts webpage.

Premium payments

Learn more on the Paying for benefits and the Premium payment plan (IRC Section 125) webpages.

PEBB Continuation Coverage

COBRA and Unpaid Leave resources
  • Initial notice of COBRA and Continuation Coverage rights 2023
  • Continuation Coverage Election Notice 2023

Learn more on the COBRA and Unpaid Leave webpages.

PEBB retiree insurance

PEBB retiree insurance resources

Learn more on the Retiring and PEBB Retiree Insurance webpage.