Forms & publications

Use this form to enroll in or change your enrollment options for COBRA coverage.

The 2026 PEBB Continuation Coverage (COBRA/Employer Group Ended Participation) Election/Change form. Use this form to enroll in or change your enrollment options for COBRA or Employer Group Ended Participation coverage.

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

These are the 2025 monthly premiums for PEBB Continuation Coverage (Employer Group Ended Participation) members.

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

The 2026 PEBB Continuation Coverage (Unpaid Leave) Election/Change form. Use this form to enroll in or change your enrollment options for PEBB Continuation Coverage (Unpaid Leave).

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.

These are the Public Employees Benefits Board (PEBB) medical plans offered for PEBB Continuation Coverage (COBRA, Unpaid Leave, and Employer Group Ended Participation) subscribers in 2026. These premiums do not include the monthly premium surcharges, if applicable to your account.

These are the monthly premiums for PEBB Continuation Coverage subscribers in 2025. These premiums do not include the monthly premium surcharges, if applicable.

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