Forms & publications

Use this form to have your employer withhold money from your paychecks and deposit it into your health savings account (HSA) on a pretax basis. Check with your payroll department before submitting this form; not all employers can arrange for payroll deductions. You must be enrolled in a consumer-directed health plan (CDHP) with an HSA before you can start a payroll deduction.

This guide explains everything about PEBB benefits for public employees.

Guidance on PEBB benefits available to public employees and their dependents. This guide includes information on eligibility, enrollment, dependent verification, benefits (medical, dental, vision coverage, life insurance, long-term disability insurance, flexible spending arrangements, the dependent care assistance program, and SmartHealth wellness program), medical plan premiums, medical plans available, premium surcharges, how to change coverage, and how to file an appeal.

This is the 2025 PEBB Employee Enrollment/Change form. Use this form to make changes to your benefits.

This is the 2025 PEBB Employee Enrollment/Change form for Medical only groups. Use this form to make changes to your benefits.

These premiums apply to PEBB employees in state agencies, higher-education institutions, and community and technical colleges. These premiums do not include the monthly premium surcharges, if applicable to your account.

These are the PEBB employee premiums for medical plans offered for 2025. These premiums apply to employees in state agencies, higher-education institutions, and community and technical colleges. These premiums do not include the monthly premium surcharges, if applicable.

This publication lists the monthly medical premiums for school employees in 2025.

Submit this form with your enrollment form if you are enrolling an extended (legal) dependent child.

Submit this form with your enrollment form if you are enrolling an extended (legal) dependent child.