Forms

Member, Admin and Vendor Forms

Open Enrollment is October 1, through October 31, 2025. If you completed Open Enrollment between October 1, and October 31, 2025, changes or corrections are allowed until February 28, 2026.

For mailing, questions and benefit contacts, visit our Contact Information page.

Log in to your Member Account., to complete your Open Enrollment benefit selections through the PEBB database (PDB).

Completing forms:

1. Open a form by clicking the link under Document Title.
2. Save it to your computer before filling it out or information you've entered might be lost.
3. Please complete all fields.
4. Save your completed form before sending or sharing it.