Bookmark & ShareAre you a new employee? Here's your enrollment packet.
This information describes the benefits available to you through the Public Employees Benefits Board (PEBB) Program. You must complete and return the appropriate forms to your personnel, payroll, or benefits office within 31 days of eligibility to receive coverage, or you will lose certain benefit rights.
If you have questions, contact your personnel, payroll, or benefits office.
Select the description that fits you:
For employees with medical and dental benefits:
2009 Enrollment
2009 Employee Enrollment Guide (1.4 MB)
- Contact the plans
- Browse benefits
- Compare plan costs
- Find a plan in my county
- 2009 Employee Enrollment/Change form (435.8 KB)
- Covering family members on your account? Complete the appropriate forms:
- 2009 Spouse or Qualified Domestic Partner Certification (447.9 KB)
- 2009 Student Certification/Change (234.3 KB)
- 2009 Certification of Dependents With Disabilities (311.4 KB)
- 2009 Extended Dependent Certification (243.5 KB)
Medical Flexible Spending Account (FSA) - Summary and Overview (289.5 KB)
Dependent Care Assistance Program (DCAP) - Summary and Overview (289.5 KB)
2009 Life insurance booklet (1.2 MB)
- 2009 Life insurance enrollment form (139.5 KB)
- 2009 Life insurance evidence of insurability form (97.8 KB)
2009 Long term disability booklet (333.6 KB)
- 2009 Long term disability enrollment/change form (109.3 KB)
- 2009 Long term disability evidence of insurability form (101 KB)
Auto and home insurance (555.6 KB)
Long-term care insurance (144.1 KB)
2010 Enrollment
2010 Employee Enrollment Guide (1.3 MB)
- Contact the plans
- Browse benefits
- Compare plan costs
- Find a plan in my county
- 2010 Employee Enrollment/Change form (389.8 KB)
- Covering family members on your account? Complete the appropriate forms:
Medical Flexible Spending Account (FSA) - Summary and Overview (289.5 KB)
Dependent Care Assistance Program (DCAP) - Summary and Overview (289.5 KB)
2010 Life insurance booklet (366 KB)
- 2010 Life insurance enrollment form (101.3 KB)
- 2010 Life insurance evidence of insurability form (80.5 KB)
2010 Long term disability booklet (170 KB)
- 2010 Long term disability enrollment/change form (45 KB)
- 2010 Long term disability evidence of insurability form (42.1 KB)
Auto and home insurance (555.6 KB)
Long-term care insurance (135.2 KB)
