Forms and publications

Access manuals, forms, enrollment guides, and other resources to support benefits administrators (BAs) with the administration of School Employees Benefits Board (SEBB) benefits.

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Below you will find manuals, user guides, and resources related to the Benefits 24/7 online enrollment system, accounting, correcting SEBB organization errors, appeals, and HCA Support. Employee enrollment resources, such as guides and forms, certification forms for dependents, and many other resources are also available to download.

When printing forms to share with employees, also provide the SEBB nondiscrimination statement and language access notice.

Benefits 24/7

Benefits 24/7 manuals and resources

The following resources are for benefits administrators (BAs).

Learn more on the Administering SEBB in Benefits 24/7 webpage.

Accounting

Accounting manuals and resources

The accounting manual contains the current year's invoicing dates along with other accounting-related guidance.

These resources can also be found on the Accounting webpage.

Supplemental benefits billing resources

Life and accidental death and dismemberment (AD&D) insurance

MetLife manages billing and processes enrollment and claims for SEBB life and accidental death and dismemberment insurance.

Long-term disability (LTD) insurance

The Standard manages billing and processes claims for SEBB long-term disability insurance (LTD).

Flexible Spending Arrangements (FSAs) and the Dependent Care Assistance Program (DCAP)

Navia manages billing and processes claims for the SEBB Program's Medical Flexible Spending Arrangement (FSA), Limited Purpose FSA, and the Dependent Care Assistance Program.

These resources can also be found on the Accounting webpage.

Correcting SEBB organization errors

Error correction resources

Learn more on the Correcting SEBB organization errors webpage.

Appeals

Appeals form and resources

Learn more on the Appeals process webpage.

HCA Support

HCA Support is a secure, web-based correspondence program that allows you to send documents and communicate directly with O&T, SEBB Accounting, and other departments within the SEBB Program by using the ​​​​designated tile named, "Benefits administrator inquiry".

HCA Support resources

It's important that BAs use the designated tile named, "Benefits administrator inquiry". Using the "General Support" tile will lead to a delayed response, as your inquiry will be initially routed to units at HCA that are outside of O&T.

Employees and dependents

Enrollment guide, forms, and resources

Employees are encouraged to complete enrollment online using Benefits 24/7. However, the forms provided below can also be used for employee and dependent enrollment.

  • School Employee Enrollment Guide (2024) (2025)
  • The following school employee enrollment and change forms can be used by eligible employees of SEBB organizations:
    • School Employee Enrollment form (2024) (2025)
    • School Employee Change form (2024) (2025)
  • The following school employee enrollment/change form can be used by employees of SEBB employer groups who contract with the SEBB Program to offer medical-only benefits to their eligible employees:
    • School Employee Enrollment/Change form - Medical only groups (2024) (2025)
  • LTD Enrollment/Change form

Employees may use the following forms to complete their enrollment in supplemental life and supplemental accidental death and dismemberment (AD&D) insurance and to elect participation in a flexible spending arrangement (FSA) or the Dependent Care Assistance Program (DCAP). Enrollment in these benefits cannot be completed using Benefits 24/7.

Learn more on the Employee enrollment webpage.

Dependent forms and resources

Learn more on the Dependents webpage.

Premium surcharges
  • Premium Surcharge Attestation Change form (2024) (2025)
  • Spousal Plan Calculator (print version) (2024) (2025)
  • Spousal Plan Calculator (interactive tool) (2024) (2025)

Learn more on the Premium surcharges webpage.

Life and accidental death and dismemberment (AD&D) insurance

Life and AD&D forms and resources

Learn more on the Life and AD&D webpage.

Long-term disability (LTD) insurance

LTD forms and resources

Learn more on the LTD webpage.

Flexible Spending Arrangements (FSAs) and Dependent Care Assistance Program (DCAP)

FSA and DCAP forms and resources

Learn more on the FSA and DCAP webpage.

Additional forms and resources

Apple Health (Medicaid)
Dual enrollment

Learn more on the Employee enrollment webpage

Health Savings Account (HSA)
Premium payments

SEBB Continuation Coverage

COBRA and Unpaid Leave resources
  • Initial notice of COBRA and Continuation Coverage rights (2024) (2025)
  • Continuation Coverage Election Notice (2024) (2025)

Learn more on the COBRA and Unpaid Leave webpages.

PEBB retiree insurance

PEBB retiree insurance resources

Learn more on the Retirees website.