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Get the free 2024 PEBB Retiree Election Form (form A)

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2024 MEDICARE ADVANTAGE SELECTION FORM Retiree Name:___ Spouses Name: ___ Please check this box if your spouse is NonMedicare EligiblePlease choose one of the following: RETIREE ENROLLS IN COVERAGE
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How to fill out 2024 pebb retiree election

01
Begin by obtaining a copy of the 2024 PEBB Retiree Election form.
02
Read the instructions carefully to understand the requirements.
03
Provide your personal information, such as name, address, and contact details.
04
Indicate your retirement eligibility and select the appropriate retirement plan.
05
If applicable, provide information about your spouse or domestic partner.
06
Choose your desired medical and dental plans, and select any additional coverage options.
07
If you have dependents, provide their information and select the coverage options for them.
08
Review all the information provided for accuracy and completeness.
09
Sign and date the form.
10
Submit the filled-out form as instructed, either by mail or online.

Who needs 2024 pebb retiree election?

01
Any retiree who is eligible for the 2024 PEBB retiree election needs to fill out the form. This applies to individuals who are retiring or have already retired from PEBB-eligible employment and wish to enroll or make changes to their insurance plans for the upcoming year.
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The PEBB retiree election form is a document that allows retirees to select their health insurance coverage options provided by the Public Employees Benefits Board (PEBB).
Retirees who wish to enroll in or change their health insurance coverage must file the PEBB retiree election form.
To fill out the PEBB retiree election form, provide accurate personal information, select the desired health plan options, and submit the form within the specified enrollment period.
The purpose of the PEBB retiree election form is to facilitate the selection and enrollment of retirees in the health benefits they wish to receive.
The information that must be reported includes the retiree's name, contact information, Social Security number, and selected health insurance plans.
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