WWU Benefits Forms and Publications
Medical and Dental Insurances
This page contains a list of medical and dental forms and publications. Navigate the left side to find a full list of forms and publications specific to retirement and insurances.
Unless otherwise noted on the form, please send completed documents to the WWU Benefits Office, Mail Stop 9054.
If you prefer to hand-deliver documents or send them through U.S. mail,
click here. Read the form carefully to see whether additional documentation is required.
Be sure to make copies of documents for your records before submitting them as we cannot make copies for you.
If you cannot find a form or publication on this page or through one of the links shown at right, contact
firstname.lastname@example.org. One of our team will respond to your request.
Medical and Dental Forms for Faculty & Staff
Medical and Dental Publications/Resources for Faculty & Staff
PEBB Employee Enrollment Guides
Summary of all Public Employee Benefits Board (PEBB) benefits including medical, dental, long term disability, life, etc.
Medical Plans - Summaries of Benefits and Coverage (SBC)
For an easier, more standardized comparison tool of medical plan benefits, terms, and conditions, see the
PEBB Summary of Benefits and Coverage. The SBC is also available upon request in Spanish, Tagalog, Chinese, and Navajo.
Medical Plans - Benefits Booklets
Find the Benefits Booklet (Certificate of Coverage) at your medical plan's website listed below:
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Dependents with Disabilities
Use this form to request certification of a disabled dependent.
Extended (legal) Dependents
Use this form to request certification of a dependent child who is not yours through birth, adoption, marriage, or a qualified domestic partnership.
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COBRA—Continuation of Coverage Election Forms
Self-Pay Insurance Forms
Health Savings Account (HSA) Forms
Health Savings Account (HSA) Publications/Resources
HSA Forms, Publications, Tutorials
HealthEquity (HE) is the trustee for Public Employee Benefits Board (PEBB) members' Health Savings Accounts.
Get publications and tutorials.
Qualified & Non-Qualified Medical Expenses
(Gastos Médicos Calificados Y No Calificados)
Download this publication in
English and Español. (PDF format)
Complete HSA Guidebook
Download the HSA Guidebook. (large download in PDF format)
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Flexible Spending Account (FSA) Forms
FSA Forms and Publications
To download a FSA Form or document, see
Flex-Plan Services website.
Mail FSA forms directly to: Flex-Plan Services, PO Box 53250, Bellevue, WA 98015 or fax to 1-425-451-7002.
Western Washington University