Forms & publications

Use this form if you are requesting an appeal of a decision.

This nondiscrimination statement describes how the PEBB Program and its contracted health plans comply with applicable federal civil rights laws.

This benefits book describes what is covered as a SEBB member under Premera High PPO plan, including medical services and prescription drugs, as well as specific services not covered by the plan. Finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays. It also includes how to request an appeal, submit a claim, and how Medicare works with your plan.

This benefits book describes what is covered under Premera High PPO, including medical services and prescription drugs, as well as specific services not covered by the plan. Finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays. It also includes how to request an appeal, submit a claim, and how Medicare works with your plan.

A summary of what the SEBB Premera High PPO plan covers and what it costs.

A summary of what the SEBB Premera High PPO plan covers and what it costs.

This benefits book describes what is covered as a SEBB member under Premera HMO plan, including medical services and prescription drugs, as well as specific services not covered by the plan. Finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays. It also includes how to request an appeal, submit a claim, and how Medicare works with your plan.

This benefits book describes what is covered under Premera HMO, including medical services and prescription drugs, as well as specific services not covered by the plan. Finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays. It also includes how to request an appeal, submit a claim, and how Medicare works with your plan.

A summary of what the SEBB Premera HMO plan covers and what it costs.

A summary of what the SEBB Premera HMO plan covers and what it costs.