Mailing Address

In order to update your address with your doctor or insurance plan, you will need to update your mailing address in My Evergreen Pay History and Information. If you choose to send us an email to request the address change, please include your full legal name, Evergreen ID number (A#), and complete address including zip code.

Medical & Dental Plan Changes

Annual Open Enrollment for PEBB benefits is November each year. Certain life events also create Special Open Enrollment opportunities.

You can add or remove a dependent outside of open enrollment within 60 days of a qualifying event.

1. Download the Employee/Enrollment Change form from PEBB Forms.
2. Submit the completed form along with the required dependent verification and evidence of the event to the Payroll & Benefits Office.

Coverage dates and qualifying events are described on our Special Open Enrollment page.

Beneficiary Changes

To change your beneficiaries, download the applicable form.

• Life Insurance Beneficiary form (PDF) - return to the Payroll and Benefits Office
• Department of Retirement Systems Beneficiary - mail to DRS
• TIAA-CREF - to change beneficiaries you will need to contact TIAA-CREF directly.

Optional Life Insurance Coverage

• To increase the amount of your coverage:  Download the Life and AD&D Insurance/Enrollment Change form and the Life Insurance Evidence of Insurability form from the PEBB Forms web page.  Return the completed forms to the Payroll and Benefits office.
• To decrease the amount of your coverage: Download the Life and AD&D Insurance/Enrollment Change form from the PEBB Forms web page.  Return the completed form to the Payroll and Benefits office.

Optional Long Term Disability Insurance

• To enroll or decrease your waiting period:  Download the Long Term Disability Enrollment/Change form and the Long Term Disability Evidence of Insurability form from the PEBB Forms web page.  You can mail or hand deliver the completed forms to the Payroll and Benefits office.  We will mail them for you.
• To increase your waiting period:  Download the Long Term Disability Enrollment/Change form from the PEBB Forms web page.  Turn the completed form into the Payroll and Benefits office.

TIAA-CREF Voluntary Investment Plan

• If you currently contribute to a VIP and wish to change the amount download the Salary Reduction Agreement VIP (PDF). Turn the completed form into the Payroll and Benefits office.

• If you do not currently have a TIAA-CREF Voluntary Investment Plan - you can pick up the enrollment kit at the Payroll and Benefits office or request that one be mailed to you.

Washington State Deferred Comp

Complete your Deferral Change Request online at  Washington State Deferred Compensation Program.  You can also change your contribution amount by calling 888-327-5596.  DCP will inform the Payroll Office of changes you make.

W-4

When you have family changes you may also wish to change your W-4