SEBB Forms

SEBB Employee Request for Review/Notice of Appeal Form

SEBB Employee Change Form

SEBB Premium Surcharge Attestation Help Sheet

SEBB Premium Surcharge Attestation Change Form

2021 SEBB Spousal Plan Calculator

SEBB Declaration of Tax Status 2021

SEBB Extended Dependent Certification 2021

SEBB Certification of a Child with a Disability 2021

HSA Deduction Form 2021 (Begin a deduction, Change your deduction, Stop your deduction)

HSA Beneficiary Designation Form

SEBB Continuation Coverage (COBRA) Election/Change Form 2021

SEBB Continuation Coverage (Unpaid Leave) Election/Change Form 2021


MetLife Forms - Life Insurance

MetLife Enrollment/Change Form

MetLife Beneficiary Form * Employer Name is WA State Health Care Authority SEBB and Customer Number is 219743

*Change your supplemental coverage amounts or update beneficiaries online


Navia Forms - FSA/DCAP

FSA/DCAP Enrollment Form for Newly Eligible Staff Only

FSA/DCAP Enrollment Form for Staff Approved for Special Open Enrollment Event

FSA/DCAP Claim Form

DCAP Recurring Claim Form

FSA/DCAP Termination Form

FSA/DCAP Transfer Form (When you resign with Tahoma but go to work for another Washington School District-SEBB Benefits transfer with you.)

The Standard Forms-Supplemental LTD

Supplemental Long-Term Disability Enrollment and Change Form

Supplemental Long-Term Disability Medical History Statement (Evidence of Insurability)

Website by SchoolMessenger Presence. © 2024 SchoolMessenger Corporation. All rights reserved.