Forms & publications

Use this form to disenroll from a Medicare Advantage plan.

This chart briefly compares the per-visit costs of some in-network benefits for PEBB Medicare medical plans. Some copays and coinsurance do not apply until after you have paid your annual deductible. Call the plans directly for more information on specific benefits, including preauthorization requirements and exclusions.

Use this form to disenroll from Medicare Advantage.

This is the MetLife accidental death and dismemberment (AD&D) insurance certificate of coverage (COC) for PEBB employees.

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

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

Use this form to name the persons or entities you want to receive your life insurance proceeds after your death. Return this form to MetLife.

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

MetLife accidental death and dismemberment (AD&D) insurance certificate of coverage (COC) for SEBB members who work at least 630 hours.

MetLife accidental death and dismemberment (AD&D) insurance certificate of coverage (COC) for SEBB members who work less than 630 hours.