Bookmark & ShareAre you a new retiree or planning to retire? This page describes the health benefits available to you through the Public Employees Benefits Board (PEBB) Program.
2012 Enrollment
(for retiree enrollment beginning January 1, 2012)
2011 Enrollment
- How Can I Learn More About The Benefits and Enrollment Process?
- What Are The Benefits?
- When Are My Enrollment Forms Due?
- Covering Family Members on Your Account?
- Enrolling in a Medicare Advantage Plan?
- Enrolling in a Medicare Supplement Plan
How Can I Learn More About The Benefits and Enrollment Process?
Register to attend a retirement seminar from the Department of Retirement Services.
Read the Retirement Overview
Read the 
Retiree Enrollment Guide
See video about enrollment process and benefits
Retiree enrollment forms (Need help with enrollment forms?)
What Are The Benefits?
Medical and Dental
Compare medical plan benefits
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 Insurance Provided by ReliaStar Life Insurance Company
Summary (73 KB)
Booklet: Term Life Insurance Certificate (349.1 KB)
Group Life Portability Application
Auto and Home Insurance
Summary (78.5 KB)
Long-term Care Insurance
Summary (61 KB)
When Are My Enrollment Forms Due?
You must enroll in or defer retiree health coverage no later than 60 days from the date your active employer or continuous COBRA coverage ends. To do this, complete the Retiree Coverage Election Form (Form A ), and mail or hand-deliver it to us no later than 60 days after your active employer or continuous COBRA coverage ends. If you don't, you will lose your right to enroll later.
If you and/or your covered dependents are entitled to Medicare Part A and Part B, you must enroll in both Part A and Part B to qualify for retiree health coverage. You must send a copy of your and your covered dependent's Medicare card to PEBB as proof of enrollment.
Covering Family Members on Your Account?
Complete the appropriate forms:
- Declaration of Tax Status - if covering a domestic partner
- Dependents With Disabilities Certification - if covering a dependent over age 25 with a disability
- Extended (Legal) Dependent Certification - if covering an extended dependent (What is an extended dependent)
Enrolling in a Medicare Advantage Plan?
You will need to fill out and send in Form A and the Medicare Advantage Enrollment (Form C) to PEBB.
Enrolling in a Medicare Supplement Plan?
You will need to fill out and send in Form A and the Medicare Supplement Enrollment (Form B) to PEBB.
2012 Enrollment
- How Can I Learn More About The Benefits and Enrollment Process?
- What Are The Benefits?
- When Are My Enrollment Forms Due?
- Dependent Certifications
- Enrolling in a Medicare Advantage Plan?
- Enrolling in a Medicare Supplement Plan
How Can I Learn More About The Benefits and Enrollment Process?
Register to attend a retirement seminar from the Department of Retirement Services.
Read the Retirement Overview
Read the Retiree Enrollment Guide (1.4 MB)
Retiree enrollment forms (Need help with enrollment forms?)
What Are The Benefits?
Medical and Dental
Compare medical plan benefits
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 Insurance Provided by ReliaStar Life Insurance Company
Summary (579.8 KB)
Booklet: Term Life Insurance Certificate (349.9 KB)
Group Life Portability Application (58.9 KB)
Auto and Home Insurance
Summary (78.5 KB)
Long-term Care Insurance
Summary (61 KB)
When Are My Enrollment Forms Due?
You must enroll in or defer retiree health coverage no later than 60 days from the date your active employer or continuous COBRA coverage ends. To do this, complete the Retiree Coverage Election Form (Form A ), and mail or hand-deliver it to us no later than 60 days after your active employer or continuous COBRA coverage ends. If you don't, you may lose your right to enroll later unless you regain eligibility.
If you and/or your covered dependents are entitled to Medicare Part A and Part B, you must enroll in both Part A and Part B to qualify for retiree health coverage. You must send a copy of your and your covered dependent's Medicare card to PEBB as proof of enrollment.
Dependent Certifications
Complete the appropriate forms:
- Declaration of Tax Status - if covering a domestic partner (240.4 KB)
- Dependents With Disabilities Certification - if covering a dependent over age 25 with a disability (297 KB)
- Extended (Legal) Dependent Certification - if covering an extended dependent (290.2 KB) (What is an extended dependent)
Enrolling in a Medicare Advantage Plan?
You will need to fill out and send in Form A and the Medicare Advantage Enrollment (Form C) to PEBB.
Enrolling in a Medicare Supplement Plan?
You will need to fill out and send in Form A and the Medicare Supplement Enrollment (Form B) to PEBB.
