Get the free MSC 5507 PEBB Retiree Enrollment. MSC 5507 PEBB Retiree Enrollment and Corrections form

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Office uses only Approved by:Retiree Enrollment Preapproved date:Effective date:See the Summary Plan Description for more information on benefits at www.pebbinfo.com. Section 1: Enrollment type c

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What is msc 5507 pebb retiree?

MSC 5507 PEBB retiree refers to the form used by retirees covered under the Public Employees Benefits Board (PEBB) to report their health insurance coverage information.

Who is required to file msc 5507 pebb retiree?

Retirees who are enrolled in PEBB health insurance plans are required to file MSC 5507 PEBB retiree to report their coverage status and enrollment details.

How to fill out msc 5507 pebb retiree?

To fill out MSC 5507 PEBB retiree, individuals need to provide personal information, coverage details, and any dependent information as requested on the form.

What is the purpose of msc 5507 pebb retiree?

The purpose of MSC 5507 PEBB retiree is to ensure that the PEBB receives accurate information regarding retirees' health insurance coverage and to maintain eligibility for benefits.

What information must be reported on msc 5507 pebb retiree?

The information that must be reported includes the retiree's name, PEBB identification number, health insurance plan details, and any dependents' information.

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