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Human Resources

Benefits: Forms

InsuranceNumerous forms are available on the PEBB forms webpage: www.pebb.hca.wa.gov/formsYou will find the following:Medical/Dental Enrollment and ChangeLife Insurance Enrollment and ChangeLong Term Disability Insurance Enrollment and ChangeNonsmoker CertificationDependent CertificationCOBRA Continuation of Coverage ElectionRequest to Cancel Dependent CoverageHSA Optional Contributions(Only employees enrolled in a consumer-directed health plan are eligible to contribute to an HSA.)Name and Address

Retirement and Savings

Flexible Spending Account / Dependent Care