Benefit Information and Forms
Medical Benefit Forms
PEHP Enrollment and Change FormPEHP Flex SpendingPEHP Flex Day CareHealth Savings Employee Contribution (HSA)
Medical Plan Benefit Information
- Benefits and Coverage Glossary
- PEHP Website
- PEHP Provider List
- Eyemed Benefit Summary - Eyewear
- Eyemed Benefit Summary - Full
- Opticare Plan - Eyewear
- Opticare Plan - Full
- Consumer Plus Summary of Benefits and Coverage
- STAR HSA Summary of Benefits and Coverage
- Traditional Summary of Benefits and Coverage
- Dental Grids
- STAR Plan Medical Grid
- Traditional Plan Medical Grid
- PEHP 2022 Notices
- Employer's Creditable Coverage
Life Insurance Benefit Information/Forms
- Cigna Enrollment Form
- Cigna Enrollment Form - Spanish
- Cigna AD&D
- Cigna AD&D - Spanish
- Cigna Term Life Insurance
- Cigna Term Life Insurance - Spanish
- Cigna Long-Term Disability Insurance
- Cigna Long-Term Disability Insurance - Spanish
- Cigna Short-Term Disability Insurance
- Cigna Short-Term Disability Insurance - Spanish
- Cigna Voluntary Life Insurance
- Cigna Voluntary Life Insurance - Spanish