2009 Benefit Information and Forms
2009 Summary Plan Document - Benefit Handbook (Plan descriptions, rates and eligibility information)
Log In to PEBB.benefits (online benefits system)
Public Employee Benefit Board (PEBB) website
PEBB Core Benefits Information - (Plan information, provider searches, member handbooks, etc.)
- Medical (including prescription)
- Vision
- Dental
- Basic Life
- Medical Opt Out
2009 Medical/Dental Premium and Contribution Chart for Part Time Classified Employees
Post-Doc (self-pay) Employee Benefit Information
PEBB Optional Insurance Benefits Information
- Optional Life (Employee, Spouse/Partner and Dependent)
- Disability
- Accidental Death & Dismemberment
- Long Term Care
Flexible Spending Accounts Information
- Healthcare
- Dependent Care
- Reimbursement Form
ASIFlex website (eligible expenses and forms etc.)
2009 Update Forms
- PEBB Medical/Dental Update Form
- PEBB Life/Disability Update Form
- PEBB Dependent Care Flexible Spending Account Update Form
- PEBB Healthcare Flexible Spending Account Update Form
- PEBB Designation of Beneficiary Update Form
2009 Enrollment Forms
- Medical/Dental Enrollment Form
- Life and Disability Enrollment Form
- Standard's Medical History Statement (paper form)
- Standard's Medical History Statement (complete and submit online)
- Healthcare Flexible Spending Account Enrollment Form
- Dependent Care Flexible Spending Account Enrollment Form
- Domestic Partner Affidavit