Declaration of tax status (SEBB) 2020

School Employees and SEBB Continuation Coverage must complete and submit this form with their enrollment form when enrolling an individual on their SEBB Program coverage who does not qualify as their dependent for federal tax purposes.

Form

SEBB Continuation Coverage (COBRA) Election/Change Form 2020

20-0060

Use this form to enroll in or change your enrollment options for SEBB Continuation Coverage (COBRA) coverage.

Form

SEBB Continuation Coverage (Unpaid Leave) Election/Change Form 2020

20-0059

Use this form to enroll in or change your enrollment options for SEBB Continuation Coverage (Unpaid Leave) coverage.

Form