How to enroll
Find the required forms and timelines to enroll in PEBB benefits.
On this page
To enroll in PEBB benefits, your personnel, payroll, or benefits office must receive the following forms within the timelines listed:
- Employee Enrollment/Change form (if your employer offers the full benefits package) or Employee Enrollment/Change for Medical Only Groups form (if your employer offers PEBB medical coverage only): No later than 31 days from the date your eligibility begins.
- Life and AD&D Insurance Enrollment/Change form: No later than 31 days from the date your eligibility begins.
- Long-Term Disability Enrollment/Change form: No later than 31 days from the date your eligibility begins.
Generally, you become eligible your first day of employment. Ask your personnel, payroll, or benefits office when your eligibility begins.
If your personnel, payroll, or benefits office doesn’t receive your completed form(s) and verification documents for your dependents (if any) 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. You will owe medical premiums back to the date your eligibility began. You cannot change plans or enroll eligible dependents until the next annual open enrollment, unless you have a special open enrollment that allows the change.
If you enroll family members on your PEBB coverage, you must provide proof of their eligibility within the enrollment timelines listed above or the family members will not be enrolled. See Dependent verification. You will need these forms:
- Declaration of Tax Status - To enroll a state-registered domestic partner or a state-registered domestic partner's child
- Certification of Dependent With a Disability - To enroll a dependent child with a disability over age 26
- Extended Dependent Certification - To enroll an extended (legal) dependent child
An enrolled dependent 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 benefits, you need to decide which of you will cover yourselves and any eligible children on your medical or dental plans. 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 dental, basic life, and basic LTD insurance under your own account. See Waiving medical coverage.
You may waive PEBB medical if you are enrolled in other employer-based group health insurance, TRICARE, or Medicare. You must submit a form to waive 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, and basic LTD insurance coverage begins on the first day of the month after 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, and basic LTD insurance begins on the first of the month after the beginning of the second consecutive quarter/semester of halftime or more employment. If the first day of the second consecutive quarter/semester is the first working day of the month, benefits begin on that day.
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 annual open enrollment or if you have a special open enrollment event that allows the change.