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Name: Fillable Online Pebb 2025 Open Enrollment Form for Flexible Spending Arrangements (fsa) & Dependent Care Assistance Program (dcap) Fax Email Print - pdfFiller
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This form is used for enrolling in Flexible Spending Arrangements and the Dependent Care Assistance Program during the PEBB Program’s annual open enrollment period. The form includes sections for employee information, benefit elections, and terms related to the enrollment process, along with requirements and limits for various spending arrangements.

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How to fill out pebb 2025 open enrollment

01

Review the PEBB 2025 Open Enrollment materials provided by your employer.

02

Gather necessary information such as your current plan details, dependents’ information, and any changes you're considering.

03

Access the online enrollment portal or obtain a paper enrollment form.

04

Follow the step-by-step instructions to fill out your personal information accurately.

05

Select the health plans you wish to enroll in or make changes to your current plans.

06

Review your selections carefully to ensure they meet your needs.

07

Submit your enrollment application by the deadline specified in the Open Enrollment materials.

Who needs pebb 2025 open enrollment?

01

All employees who are eligible for PEBB (Public Employees' Benefit Board) benefits.

02

Dependents of eligible employees who need to enroll or make changes to their health coverage.

03

Any employee who wants to review and potentially change their current health plan options.

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What is pebb 2025 open enrollment?

PEBB 2025 open enrollment refers to the period during which eligible employees can enroll in or make changes to their health insurance plans for the 2025 coverage year through the Public Employees' Benefit Board (PEBB).

Who is required to file pebb 2025 open enrollment?

All eligible employees and their dependents who wish to enroll or make changes to their health insurance plans for the year 2025 are required to file for PEBB open enrollment.

How to fill out pebb 2025 open enrollment?

To fill out the PEBB 2025 open enrollment, eligible employees typically complete an enrollment form provided by their employer or the PEBB program. This may be done online or via paper forms, including selecting desired health insurance plans and detailing any changes to dependent coverage.

What is the purpose of pebb 2025 open enrollment?

The purpose of PEBB 2025 open enrollment is to allow eligible employees to select or modify their health insurance options for the upcoming coverage year, ensuring that they have access to the health benefits that best meet their needs.

What information must be reported on pebb 2025 open enrollment?

During PEBB 2025 open enrollment, individuals must report personal information such as their names, Social Security numbers, dependent information, and the health plans they wish to enroll in or modify.

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