Medical and Supplemental Insurance

Please refer to your PEBTF Summary Plan Description for full details on dependent eligibility and enrollment requirements.  You may enroll your eligible spouse, stepchildren, domestic partners, and children of domestic partners at any time.  However, the effective date cannot be more than 60 days retroactive from the date the PEBTF Enrollment/Change form is received by your Human Resource office.  

For employees with a current hire date on/after 8/1/2003, if your spouse/domestic partner is eligible for coverage through their own employer or retiree health plan, they must be enrolled in that plan for primary coverage.  

The following documentation must be provided to your Human Resources office:

Spouse/Stepchildren
1. A completed PEBTF-2 Enrollment/Change Form AND;
2. Employees hired on/after 8/1/2003 must also provide:

- A completed PEBTF-11 Declaration of Spouse/Domestic Partner Coverage, AND;
- If applicable, copies of your spouse’s insurance cards AND;
- If applicable, a PEBTF-36 Employer Benefit Verification Form AND;

3. Your original marriage certificate (A representative from the Human Resources office must initial your enrollment form confirming they saw the document.)
4. If enrolling stepchildren, original birth certificates listing your spouse as the parent.

Domestic Partner/Domestic Partner Children*
1. PEBTF-12 Domestic Partner Verification Statement and Application for Health Benefits, including copies of three evidence documents listed on the form AND;
2. A completed PEBTF-2 Enrollment/Change Form AND;
3. Employees hired on/after 8/1/2003 must also provide:

- A completed PEBTF-11 Declaration of Spouse/Domestic Partner Coverage, AND;
- If applicable, copies of your spouse’s insurance cards AND;
- If applicable, a PEBTF-36 Employer Benefit Verification Form AND;

4. If enrolling your domestic partner’s children, original birth certificates listing your partner as the parent.

  *NOTE: Enrollments for domestic partners and children of domestic partners will no longer be accepted on or after January 1, 2020.  The PEBTF will cease providing coverage for domestic partners and children of domestic partners effective January 1, 2021.


Cost:

You may pay an additional biweekly cost to cover your dependents. Refer to the PEBTF Open Enrollment Newsletter for further details on costs. 

If enrolling a domestic partner/domestic partner’s child(ren), it may also impact your taxes. Please see the Fact Sheet-Health Coverage For Domestic Partners for further details.

Life and Accident Insurance

Voluntary Group Life and Accident Insurance (MetLife):

Add Coverage -
If you are currently enrolled in Voluntary Life and Accident coverage you may add coverage for your spouse. Complete the enrollment form and return it to your Human Resources office within 31 days of your marriage.

You may apply for voluntary life coverage or apply to increase your coverage at any time by submitting a completed enrollment form to your Human Resources office, and a Statement of Health Form to MetLife.  New enrollments and increases in coverage are subject to medical underwriting and approval by MetLife.

Update your Beneficiary Election -
Log on to Employee Self-Service (ESS) and follow these instructions if you wish to update your MetLife Voluntary Group Life and Accident Insurance beneficiary.

Employer-Paid Life Insurance (MetLife):

Update your Beneficiary Election -
Log on to MetLife wish you wish to update your employer-paid basic term life insurance beneficiary.

Flexible Spending Accounts (FSA)

Health Care FSA - To pay for your family's health care expenses not paid by insurance.

Day Care FSA - To pay for child or elder care expenses, such as daycare or summer camp.

You may enroll or change the amount you contribute to your FSA plans by completing the enrollment form and returning it to your Human Resources office within 60 days of the event.

Payroll and Taxes

You may need to adjust your withholding for federal income taxes. This can be done any time by logging into the self-service workplace, Fiori and following these instructions.

Group Retirement Plans

Consider whether you need to make any adjustments to your beneficiaries:

State Employee Retirement System (SERS) -
Complete an Active Member Beneficiary Nomination Form and return it to SERS at the address on the bottom of the first page of the form.

Alternative Retirement Plan (ARP) -
Log into your Fidelity or TIAA account to update your beneficiaries.

Voluntary Retirement Plans

Employees are eligible to enroll at any time. If you have an existing account, consider updating your beneficiaries.

Deferred Compensation 457 -
Log into your Empower retirement account to update your beneficiaries.

Tax-Sheltered Annuity 403(b) -
Log into your Fidelity or TIAA account to update your beneficiaries.

State Employee Assistance Program (SEAP)

Getting married or entering into a domestic partnership is a joyful time in your life, but can also be a time of adjustment.  SEAP provides various resources that can help during this time including counseling, financial planning, and legal services.  SEAP services are available to everyone who lives in your house, as well as your parents, adult children, and siblings regardless of where they live.  You do not need to take any action to add family members to this plan, they are automatically covered.