2010 Benefit Information
2010 PEBB Core Benefit Information (medical, dental and employee basic life)
- Statewide Medical Plan provider search
- Statewide Medical Plan Information - plan summary, customer service phone number and more!
2010 PEBB Optional Benefit Information (life, disability and AD&D)
2010 PEBB Flexible Spending Account(s) Information (heatlhcare and dependent care)
Forms:
Employee Enrollment Form - (one form applies to Medical/Dental, Life/Disability and Dependent Certification)
- Increases in optional employee and/or spouse/domestic partner life require a medical history statement to be submitted and approved by Standard Insurance.
- Electronic Medical History Statement (complete and submit online)
- PDF form (must be sent directly to Standard Insurance)
Flexible Spending Account Enrollment Form
Affidavit of Domestic Partnership - If you add a partner during open enrollment, you must submit a completed affidavit to Human Resources within 5 days of enrollment.
Benefit contributions and plan costs:
- Unclassified and Full-time Classified benefit eligible employees will continue to receive fully paid family medical/vision, dental and basic employee life insurance.
- Part-time Classified benefit eligible employees will continue to receive a prorated employer contribution/subsidy.
Public Employees' Benefit Board (PEBB)