Forms & publications

Use this form to notify MetLife that you wish to cancel your Supplemental Life Insurance and/or Supplemental Accidental Death & Dismemberment (AD&D) Insurance. For employees only: Employee Basic Life Insurance ($35,000) and Employee Basic AD&D Insurance ($5,000) is not affected by this form. It is provided by your employer at no cost to you. You cannot cancel your Employee Supplemental Life Insurance and keep Dependent Life Insurance.

This is the MetLife PEBB retiree life insurance certificate of coverage (COC) for employees.

This is the MetLife PEBB retiree life insurance certificate of coverage (COC) for retirees.

This is the MetLife PEBB retiree life insurance certificate of coverage (COC) for retirees.

Use this form to enroll in or change enrollment in retiree term life insurance through MetLife.

This benefits book describes what is covered as a SEBB member under MetLife Vision, including vision services and specific services not covered by the plan. Finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays.

Preauthorization requirements for MetLife Vision plan. Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

Use this form to enroll in or change your enrollment options for PEBB Continuation Coverage (Employer Group Ended Participation).

These are the 2024 PEBB Continuation Coverage (Employer Group Ended Participation) Premiums. These premiums do not include the monthly premium surcharges, if applicable to your account.

This is the booklet you will receive when your Public Employees Benefits Board (PEBB) health coverage ends. This booklet explains how you and your dependents can continue your PEBB health coverage. To continue PEBB health coverage, you must complete the enclosed forms and follow the instructions.