Covering Others (PEBB)

• Affidavit of Domestic Partnership
• Certification of Dependent Tax Status
• Affidavit of Child Dependency
• Affidavit of Grandchild Dependency

Miscellaneous Forms

• PEBB Appeal Form
• Prescription Prior Authorization Form

Life Insurance and Long Term Care

• Medical History Statement for Optional Life Insurance (paper form)
• Medical History Statement for Optional Life Insurance (complete and submit online)
• Standard Life Insurance Portability Form
• Transfer  of Premium Payment for Life Insurance and Long Term Care

Visit the PEBB Forms Library for access to all PEBB forms.

PEBB Forms Library