Forms and publications

Employee medical, dental, vision

• School Employees Initial Employee Enrollment Guide 2020

SEBB Continuation Coverage (COBRA and Unpaid Leave)

• SEBB Continuation Coverage Election Notice
• SEBB Continuation Coverage Election Notice Insert (for those currently enrolled in COBRA and will transition to SEBB Continuation Coverage)
• SEBB Continuation Coverage (COBRA) Election/Change form 2020
• SEBB Continuation Coverage (Unpaid Leave) Election/Change form 2020

Premium surcharges

• SEBB Premium Surcharge Attestation Help Sheet 2020
• SEBB Premium Surcharge Attestation Change form 2020
• Spousal Plan Calculator (print version) 2020
• Spousal Plan Calculator (interactive tool) 2020

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

• MetLife life and AD&D insurance Certificate of Coverage (COC) 2020 (part-time employees)
• MetLife life and AD&D insurance Certificate of Coverage (COC) 2020 (full-time employees)
• MetLife Enrollment/Change form
• Beneficiary Designation form

Long-term disability (LTD) insurance

• LTD Enrollment/Change form 2020
• LTD Evidence of Insurability
• LTD claim packet

Health Savings Account (HSA)

• Employee Authorization for Payroll Deduction for HSA 2020
• Beneficiary Designation

Medical Flexible Spending Arrangement (FSA) and Dependent Care Assistance Program (DCAP)

• Navia Benefit Solutions

Dependent certifications

• SEBB Declaration of Tax Status 2020
• SEBB Extended Dependent Certification 2020
• SEBB Certification of a Child with a Disability 2020

Miscellaneous

• SEBB Premium Payment Plan Election/Change
• Authorization for Release of Information
• SEBB Electronic Debit Service Agreement 
• School Employee Request for Review/Notice of Appeal