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Comprehensive list of Forms and Documents. Alphabetical list of PEIA forms and documents . Documents for Benefit Coordinators
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.
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.
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 ...
Download Fillable Form Sf-2817 In Pdf - The Latest Version Applicable For 2024. Fill Out The Life Insurance Election Online And Print It Out For Free. Form Sf-2817 Is Often Used In Federal Benefits, Open Enrollment, Sf Forms, Federal Employees, Federal Government, Beneficiary Designation Form, Life Insurance Form, Retirement Plan Documents, ...
completed enrollment form to your benefits coordinator • Print out your confirmation statement containing all your no later than May 15, 2021. benefit elections for you and your family.
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.
