COVID-19 Symptom Attestation

PEBB Program Annual Open Enrollment Ends Monday, Nov. 30

Time is running out…

Are you planning to:

  • Change your medical or dental plan?
  • Add or remove a dependent?
  • Update your spouse or state-registered domestic partner (SRDP) premium surcharge attestation?

Changes to medical and dental plans, removal of a dependent, and spouse or state registered domestic partner may be made through PEBB My Account until 11:59 pm on Monday, November 30, 2020. Adding a dependent that is not already listed on the account requires a paper form.

Or, complete a 2021 Employee Enrollment/Change form to make your plan changes and add or remove dependents. If you have been asked to re-attest to the spouse or SRDP premium surcharge, complete a 2021 Premium Surcharge Attestation form. Forms and any required dependent verification documents must be received by your benefits office no later than Monday, November 30, 2020.

Or, maybe you plan to:

  • Enroll or reenroll the Medical Flexible Spending Arrangement (FSA) or Dependent Care Assistance Program (DCAP)

Enroll online through the Navia Benefit Solutions website or complete the Open Enrollment form. If you are enrolling by completing the paper form, Navia Benefit Solutions must receive the form no later than Monday, November 30, 2020.

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Wednesday, November 25, 2020 - 11:35am

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