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Open Enrollment: Enrollment Instructions

Enrollment Instructions

All Changes Must be Made by Friday, November 1, 2024

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

 

Non-Medicare Retiree Members

There are two ways to enroll:

Online Enrollment

  1. This is the easiest method. Just register on the upper right of the PEBTF home page, www.pebtf.org.
  2. You will need to create a username and password if you have not already registered on the PEBTF website.
  3. Follow the instructions to complete the online enrollment.

 

Paper Enrollment Form

If you are unable to complete the online enrollment, you may complete the PEBTF Open Enrollment Form for REHP Members.  

Print the form here 2024 REHP Enrollment Form, complete it and mail it to:

Non-Medicare Eligible Open Enrollment
Pennsylvania Employees Benefit Trust Fund
150 S. 43rd Street
Harrisburg, PA 17111-5700

 

You may also call the PEBTF at 1-800-522-7279 to request a form. Make sure you give yourself plenty of time to receive, complete and return the form to the PEBTF.  

The deadline for all enrollments is Friday, November 1.

 

COBRA Members

Complete the COBRA Member Enrollment Form that you received and mail it to the PEBTF postmarked by Friday, November 1.

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