Forms & publications

Use this form to enroll in or change enrollment in retiree term life insurance through MetLife.

Use this form to enroll in or change your enrollment options for PEBB Continuation Coverage (Employer Group Ended Participation).

Use this form to enroll in or change your enrollment options for COBRA coverage.

Use this form to enroll in or change your enrollment options for PEBB Continuation Coverage (Unpaid Leave).

Use this form to enroll in Medicare Supplement Plan G administered by Premera.

Use Form E to make changes to your PEBB retiree insurance coverage.

This is the 2024 Retiree Coverage Election Form (form A). Use this form to enroll in PEBB Retiree insurance coverage. To make changes to your retiree insurance coverage, use the 2024 Retiree Coverage Change Form (form E).

This is the 2024 Retiree Enrollment Guide. It contains information you need about enrollment, eligibility, benefits, monthly premiums, and the plans available to retirees.

School board members use this form to enroll in your SEBB insurance coverage.

Guidance on SEBB benefits available to school employees and their dependents. This guide includes information on eligibility, enrollment, dependent verification, benefits (medical, dental, vision coverage, life insurance, long-term disability insurance, flexible spending arrangements, the dependent care assistance program, and SmartHealth wellness program), medical plan premiums, medical plans available, premium surcharges, how to change coverage, and how to file an appeal.