Find information on the open enrollment page that’s right for you: PEBB retirees, PEBB employees and PEBB continuation coverage subscribers, and SEBB employees and SEBB continuation coverage subscribers.
Whether you’re newly eligible or enrolling after deferring coverage, the most important thing you need to do is use Benefits 24/7 or submit the Retiree Election Form (form A) — along with any other required forms and documents based on your situation — by the required deadline. Once you have submitted your enrollment materials we will notify you of next steps.
If you are about to retire, in most cases, you have 60 days after your current coverage ends to submit an enrollment form to the PEBB Program showing that you want to enroll in PEBB retiree insurance coverage.
"Current coverage" includes:
The deadlines listed on this page indicate when the PEBB Program must receive all required forms and supporting documentation. This is not a postmark date. If we do not receive your materials by the required deadline, you may lose your opportunity to enroll.
First, you must submit your enrollment request through Benefits 24/7 or return the Retiree Election Form (form A) to the PEBB Program. After that, what you do depends on your situation.
Enroll or defer now to protect your eligibility
If you do not enroll in PEBB retiree insurance coverage when you first become eligible, you are only eligible to enroll at a later date if you deferred enrollment when you were first eligible and maintained continuous enrollment in other qualified medical coverage.
Use Benefits 24/7 to enroll or you can submit the following materials to the PEBB Program:
Eligible for Medicare? If you or a dependent are eligible for Medicare, the eligible person must enroll (and stay enrolled) in Medicare Part A and Part B.
Forms and documentation: No later than 60 days after your employer-paid, COBRA, or continuation coverage ends.
First premium payment: No later than 45 days after the 60-day period described above ends. You will not be enrolled until we receive payment.
If you select a Medicare Advantage with Part D plan or UMP Classic Medicare with Part D, enrollment cannot be retroactive. We encourage you to submit Form A (or use Benefits 24/7) so we receive it no later than the last day of the month in which your employer-paid, COBRA, or continuation coverage ends. Otherwise, you and your dependents will be enrolled in another medical plan during the gap months between when your other coverage ends and the selected Medicare plan begins.
If you are eligible to enroll and we receive your documents and payment by the deadlines, your coverage will begin the first day of the month after your employer-paid, COBRA, or continuation coverage ends.
Use Benefits 24/7 to enroll or you can submit the following materials to the PEBB Program:
Eligible for Medicare? If you or a dependent are eligible for Medicare, the eligible person must enroll (and stay enrolled) in Medicare Part A and Part B.
Forms and documentation: No later than 60 days after you leave public office.
First premium payment: No later than 45 days after the 60-day period described above ends. You will not be enrolled until we receive payment.
If you select a Medicare Advantage with Part D plan or UMP Classic Medicare with Part D, enrollment cannot be retroactive. We encourage you to submit Form A (or use Benefits 24/7) so we receive it either:
Otherwise, you and your dependents will be enrolled in another medical plan during the months between when your other coverage ends and the Medicare plan begins.
If you are eligible to enroll and we receive your documents and payment by the deadlines, your coverage will begin the first day of the month after you leave public office.
If you are a survivor, or a dependent becoming eligible as a survivor, and are ready to enroll, visit Enroll as a survivor.
If you have questions about eligibility, visit Are my survivors eligible?
You must be approved by the Department of Retirement Systems (DRS) or the appropriate higher-education authority for disability retirement before you enroll.
Use Benefits 24/7 to enroll or you can submit the following materials to the PEBB Program:
Eligible for Medicare? If you or a dependent are eligible for Medicare, the eligible person must enroll (and stay enrolled) in Medicare Part A and Part B.
Forms and documentation: No later than 60 days after the date on the Washington State-sponsored retirement systems formal determination letter.
First premium payment: No later than 45 days after the 60-day period described above ends. You will not be enrolled until we receive payment.
If you select a Medicare Advantage with Part D plan or UMP Classic Medicare with Part D, enrollment cannot be retroactive. If Form A is received after the date PEBB retiree insurance coverage is to begin, you and your dependents will be enrolled in another medical plan during the gap months prior to when the Medicare plan begins.
If you are eligible to enroll and we receive your documents and payment by the deadlines, your coverage will begin as you request on your enrollment form. Either:
This is the criteria you must meet to be eligible to enroll in PEBB retiree insurance coverage in addition to the PEBB Program receiving your form by the required deadline.
Washington State-sponsored retirement plans include:
Different rules apply if you are an elected or full-time appointed official or an employee of an employer group that does not participate in a Washington State-sponsored retirement plan. (Refer to Related laws and rules.)
You can use Benefits 24/7 to enroll in PEBB retiree insurance coverage. If you prefer a paper form, find the forms you need below.
The forms are labeled with letters in the upper right corner to help you identify them. You will often need to submit more than one form. Whether you are enrolling in coverage for the first time or after deferring coverage, the most important form you must complete and submit is Retiree Election Form (form A).
Depending on which plan you choose, you may need one or more of these retiree forms:
For the following medical plans, you need the Retiree Election Form (form A).
For Premera Blue Cross Medicare Supplement Plan G, you need both Retiree Election Form (form A) and Premera Medicare Supplement Plan G Enrollment Form (form B).
Depending on your situation, you may need to submit additional forms or documentation.
You need to submit documents that prove your dependent's eligibility (unless you are enrolled in Medicare Part A and Part B). You may also need to submit additional forms for certain dependents.
Visit Verify and enroll dependents to view a list of valid verification documents based on the type of dependent (i.e., spouse, child, etc.).
You will need to submit photocopies of Medicare cards for you or any covered dependents. Write your full name and the last four digits of your Social Security number on the copy.
Reminder: The PEBB Program must receive your forms, documentation, and payment by the enrollment period deadlines.
Submit your forms and documentation using one of the following methods.
Submit your forms through HCA Support. Attach them to a secure message. Be sure to sign them (typed signatures are not allowed).
To keep your personal information secure, you will need to register for an account (if you don't already have one) to submit your materials using this method.
Washington State Health Care Authority
PEBB Program
PO Box 42684
Olympia, WA 98504-2684
360-725-0771
If you're sending payment with your forms, enclose your check or money order payable to Health Care Authority and mail to:
Washington State Health Care Authority
PO Box 42691
Olympia, WA 98504-2691
You have three options to pay for coverage, which are described on Form A:
For details on payment options, visit Paying for benefits.
After you submit your enrollment materials, we will process them and send you a letter notifying you of next steps.
Your employer is responsible for cancelling your employee coverage. In some cases, we cannot enroll you in PEBB retiree insurance coverage until this occurs.
Washington Administrative Codes (WACs) are the official rules used for PEBB Program eligibility and enrollment.
The PEBB Program
Phone: 1-800-200-1004
TRS: 711
Hours: 8 a.m. to 4:30 p.m., Monday through Friday
HCA Support (secure, login with your personal account)
Send us a secure message or submit your forms