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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.
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.
After you fill out the form, review it to be sure it is complete and correct. The following checklist should help. REMEMBER THAT YOU, NOT YOUR AGENCY, ARE RESPONSIBLE FOR ENSURING THAT YOUR SF 2817 (OR ITS ELECTRONIC EQUIVALENT) IS CORRECT AND ACCURATELY REFLECTS YOUR INTENTIONS.
An employee may at any time file an SF 2817 to waive or reduce coverage, unless the employee has assigned his/her insurance coverage. If the employee has assigned the insurance, only the assignee(s) may waive or reduce the coverage (except for Option C which cannot be assigned). 2.
Federal Employees Group Life Insurance Program. To obtain this form go to. http://www.opm.gov/forms/pdf_fill/SF2817.pdf.
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