Forms available online

Note: Due to requirements regarding secure transmission of confidential information, we cannot post forms that may be filled and submitted online. However, you may print and complete the forms below and send via mail. Some may be filled in onscreen, then printed and mailed.

Medical forms

To find a Release of Information form, call 1-888-849-3681, or log in to your regence.com account.

Prescription drug forms

Health Savings Account (HSA) Form

Eligibility and enrollment forms

All of the forms related to eligibility, enrollment, dependent certification, payroll deduction, and more are available on the PEBB Forms and publications page: