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Open Enrollment: Enrollment Instructions for Active Members

Enrollment must be completed during Open Enrollment

October 16 – November 3, 2023

Visit the Open Enrollment section of this website for more information on your health plan choices.


If you want to change plans for January 1, 2024:

Active Members

If you have questions about your medical plan options, coverage for services, etc. please contact the PEBTF at 1-800-522-7279.

When you are ready to select a medical plan, you can use employee self service at beginning October 16, 2023 or contact commonwealth’s HR Service Center. You can call your local HR office if your agency is not supported by the commonwealth’s HR Service Center.

All online transactions must be completed and all forms must be postmarked by Friday, November 3.

COBRA Members

Complete the COBRA Member Enrollment Form that was mailed to you and mail it to the PEBTF postmarked by Friday, November 3.


Open Enrollment – COBRA
Pennsylvania Employees Benefit Trust Fund
150 S. 43rd Street
Harrisburg, PA 17111-5700