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New Employee Enrollment - Medical and Dental

Select the description that fits you:

I am an employee of a state agency, higher-education institution or community/technical college that offers PEBB medical and dental benefits.
I am an employee of a K-12 district or employer group that offers PEBB medical and dental benefits.
I am an employee of a group that offers PEBB medical benefits only.

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2013 Enrollment

• How Can I Learn More About the Benefits and Enrollment Process?
• What Are the Benefits?
• When Are My Enrollment Forms Due?

How Can I Learn More About the Benefits and Enrollment Process?

Read the 2013 Employee Enrollment Guide for enrollment, eligibility, and benefits information; it includes enrollment forms for PEBB medical and dental, life insurance, and long-term disability insurance.

See the New Employee Video that provides an orientation and overview to PEBB benefits and the enrollment process.

What Are the Benefits?

Medical and Dental

• Compare medical plan benefits
• Review eligibility for consumer-directed health plans with health savings accounts
• Review health savings account information
• Compare dental plan benefits
• Compare medical plan rates
• Find a provider who participates with your medical or dental plan
• Contact the plans or visit their websites

Life and Accidental Death & Dismemberment (AD&D) Insurance

Provided by ReliaStar Life Insurance Company

• Summary: Life & Accidental Death & Dismemberment Insurance Program (168.8 KB)
• Booklet: Life & Accidental Death & Dismemberment Insurance Program (288.2 KB)

Long-Term Disability Insurance

Provided by Standard Insurance Company

• Summary: Long-Term Disability Plan (168.5 KB)
• Booklet: Long-Term Disability Plan (440.8 KB)

Flexible Spending Account - optional

Provided by ASIFlex; available only to state agency and higher-education employees.

• Summary: Flexible Spending Account Program (160.2 KB)
• Booklet: Flexible Spending Account Program

Dependent Care Assistance Program - optional

Provided by ASIFlex; available only to state agency and higher-education employees.

• Summary: Dependent Care Assistance Program (160.2 KB)
• Booklet: Dependent Care Assistance Program

Long-Term Care Insurance - optional

Provided by John Hancock Life Insurance Company (U.S.A.)

• Summary: Long-Term Care Insurance (142.5 KB)

Auto and Home Insurance - optional

Provided by Liberty Mutual Insurance Company

• Summary: Auto and Home Insurance (140.9 KB)

When Are My Enrollment Forms Due?

For	Complete, print, and submit to your employer	No later than
Medical and Dental	Employee Enrollment/Change form (372 KB) Also complete a form below to enroll your: Domestic partner, spouse, or partner/spouse's children (233.4 KB) Dependent with a disability (279 KB) Extended dependent (226.7 KB) If enrolling family members, you must also provide documents that prove their eligibility within PEBB's timelines, or PEBB will not enroll them.	31 days after the date you become eligible (this is generally the first day of employment)
Life Insurance	Life & AD&D Insurance Enrollment/Change Form (105.5 KB) (for basic and supplemental life insurance that doesn't require prior approval) Life Insurance Evidence of Insurability Form (452 KB) (for requests that require prior approval)	60 days after the date you become eligible
Long-Term Disability (LTD) Insurance	Long-Term Disability (LTD) Enrollment/Change Form (81.5 KB) (for basic and optional LTD coverage that doesn't require prior approval) Long-Term Disability (LTD) Evidence of Insurability Form (186.6 KB) (for requests that require prior approval)	31 days after the date you become eligible
Flexible Spending Account (FSA) - optional Dependent Care Assistance Program (DCAP) - optional FSA and DCAP are available only to PEBB benefits-eligible employees at state agencies and higher-education institutions	FSA & DCAP Enrollment Form (same form for one or both programs)	31 days after the date you become eligible
Long-Term Care Insurance - optional	For an application packet, call John Hancock Life Insurance Company (U.S.A.) at 1-800-399-7271.	31 days after the date you become eligible.
Auto and Home Insurance - optional	For information and free quotes, visit PEBB’s auto/home insurance page.	You can apply for this coverage at any time.