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 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.

Benefits 24/7

Benefits 24/7 manuals and resources

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:

Insurance Eligibility Adjustment Form

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.

Accounting manuals:
Billing/invoicing dates (and state share dates for state agencies) can be found in the accounting manual for your employer type.
State payroll reconciliation resources (PEBB accounting/OFM/HRMS)
Lower limit calendar

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

Correcting employer group errors webpage

Appeals

Appeals resources for state agencies and institutions of higher education

Learn more on the Appeals process webpage.

Appeals resources for employer groups

Appeals process for employer groups webpage

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.

HCA Support
- HCA Support user guide

Employees and dependents

Enrollment guide, forms, and resources

Employees are encouraged to complete enrollment online using Benefits 24/7. However, the forms provided below can also be used for employee and dependent enrollment.

Employees may use the following forms to complete their enrollment in supplemental life and supplemental accidental death and dismemberment (AD&D) insurance and to elect participation in a flexible spending arrangement (FSA) or the Dependent Care Assistance Program (DCAP). Enrollment in these benefits cannot be completed using Benefits 24/7.

MetLife Enrollment/Change form (for electing supplemental life and AD&D insurance and adding beneficiaries)
- MetLife Beneficiary Designation form (for adding or updating beneficiaries only)
FSA and DCAP Midyear Enrollment form (for eligible employees of a state agency or institution of higher education only)

Learn more on the Newly eligible employees webpage.

Dependent forms and resources