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Comprehensive list of Forms and Documents. Alphabetical list of PEIA forms and documents . Documents for Benefit Coordinators
Standard Form 2817 Revised September 2021 Instructions for Agencies 1. Who Should File This Form? New employees eligible for life insurance who want optional insurance or no insurance. Note: New employees who want only Basic do not have to file. Employees appointed to positions that allow life insurance coverage following service in positions ...
The following is an alphabetical list of forms and documents on the Web site. If you see (Complete Online) next to a form, you can do this online by going to Manage My Benefits. It's easier, faster and leads to fewer mistakes than printing a form and sending it to PEIA.
Instructions for Agencies 1. Who Should File This Form? Y New employees eligible for life insurance who want optional insurance or no insurance. Note: New employees who want only Basic do not have to file. Y Employees appointed to positions that allow life insurance coverage following service in positions that did not allow life insurance coverage.
Standard Form 2817 – Life Insurance Election – is the form that eligible individuals use to enroll or change enrollment status under the FEGLI Program. Indicate how, by whom, and for what purpose the information is to be used.
Full instructions can be found here. ***If you have previously had PEIA as your insurance carrier, you are unable to use Manage My Benefits to log in and enroll. Please see your HR department to fill out paper enrollment forms. Preferred Provider Benefit (PPB) Plans. Comprehensive Care Program Enrollment Form.
You must use the downloadable Adobe Acrobat PDF version posted here. Previous versions are NOT usable. If individual agencies need a published version for their forms stock, they can download the PDF file and submit a printing request to the Government Printing Office.
