HCA’s lobby is now open for walk-in customer service. Learn about customer service options.

Forms and publications

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

Want to have SEBB materials delivered to your organization?

Order materials

Employee medical, dental, vision

Premium surcharges

  • Premium Surcharge Attestation Help Sheet 2022
  • Premium Surcharge Attestation Change form 2022
  • Spousal Plan Calculator (print version) 2022
  • Spousal Plan Calculator (interactive tool) 2022

Health Savings Account (HSA)

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

Long-term disability (LTD) insurance

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

Dependent certifications

  • Declaration of Tax Status 2022
  • Extended Dependent Certification 2022
  • Certification of a Child with a Disability 2022

SEBB Continuation Coverage (COBRA and Unpaid Leave)

  • Continuation Coverage Election Notice 2022
  • Initial notice of COBRA and Continuation Coverage rights 2022
  • Continuation Coverage (COBRA) Election/Change form 2022
  • Continuation Coverage (Unpaid Leave) Election/Change form 2022