South Carolina Public Employee Benefit Authority Forms
The South Carolina Public Employee Benefit Authority (PEBA) is responsible for managing and administering the employee benefit programs for public employees in South Carolina. These benefit programs include retirement plans, health insurance, dental and vision coverage, life insurance, and other related benefits. PEBA ensures that eligible employees have access to comprehensive and competitive benefit options to support their well-being and financial security.
Documents:
64
This form is used for submitting healthcare claims to the State Health Plan in South Carolina.
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This document is a certification form used in South Carolina regarding tobacco or e-cigarette use.
This document is for filing a claim for reimbursement from your Dependent Care Spending Account and Medical Care Spending Account in South Carolina.
This document is used for transferring ownership of property or assets to a trust in South Carolina. The trust becomes the new legal owner of the property.
This document is used to authorize the release of protected health information (PHI) in the state of South Carolina. It allows for the sharing of sensitive medical information between healthcare providers, insurers, and other relevant parties.
This document is used for notifying employees in South Carolina about their rights to continue their health insurance coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).
This form is used for dependents who are ineligible for Cobra coverage in South Carolina.
This form is used for providing your dependent's Social Security Number in South Carolina.
This document is for the Designated Governmental Entity in South Carolina. It refers to a specific government agency or organization authorized to carry out certain functions or responsibilities within the state of South Carolina.
This form is used for requesting a transfer to a Health Savings Account (HSA) in South Carolina. It allows individuals to consolidate their healthcare funds and take advantage of HSA benefits.
This Form is used for filing a claim for accidental death or dismemberment benefits in South Carolina. It includes details about the incident and the claimant's information.
This document notifies the former spouse of their right to elect certain benefits in South Carolina.
This form is used for South Carolina residents who are late entrants to a medical insurance plan. It collects medical history information to determine eligibility and coverage options.
This Form is used for filing a life insurance claim in South Carolina.
This document is used for verifying employment history and details of an individual in the state of South Carolina. It is commonly required by employers or organizations during the hiring process.
This form is used for employees in South Carolina to request long-term disability benefits by providing a statement about their disability.
This document is a notice that is used to terminate COBRA continuation coverage in South Carolina.
This form is used for filing an appeal regarding a Moneyplus-related matter in South Carolina.
This document is a notice regarding a qualifying event for COBRA in South Carolina. COBRA refers to the Consolidated Omnibus Budget Reconciliation Act, which provides temporary continuation of group health coverage in certain situations. The notice informs individuals of a qualifying event that may entitle them to COBRA coverage.
This Form is used for submitting an appeal request in South Carolina.
This document is for submitting a refund request in South Carolina.
This document for residents of South Carolina is used to justify the need for medical treatments or services. It is typically required by insurance companies to determine coverage eligibility.
This Form is used for requesting a review in the state of South Carolina. It is a formal process to have a decision or action reviewed and potentially reversed or modified.
This document is used by retirees in South Carolina to notify the relevant authorities of their election decisions.
This Form is used for enrolling or disenrolling in the Express Scripts Medicare plan in South Carolina.
This document is a notice informing individuals in South Carolina about an extension of their COBRA continuation coverage. COBRA allows people to maintain their health insurance coverage after certain qualifying events, such as job loss or reduction in work hours.
This document is used for issuing personal checks in the state of South Carolina. It allows individuals to make payments directly from their bank accounts for various expenses, such as bills, rent, or purchases.
This document is a confidentiality agreement for designated employees of a third-party enroller in South Carolina. It ensures that employees keep sensitive information confidential.
This document ensures that employees in South Carolina understand and agree to keep sensitive information confidential. It is used to protect the company's trade secrets and other proprietary information.
This document allows for the transfer of specific rights or interests to an individual in South Carolina. It is used for assigning rights or interests to someone else.
This form is used for requesting a premium waiver in South Carolina.
This Form is used for requesting treatment as an Assistance Eligible Individual in South Carolina.
This form is used for certifying an incapacitated child in South Carolina.
This document is a Monthly Budget Worksheet specifically designed for residents of South Carolina. It helps individuals plan and track their income, expenses, and savings on a monthly basis.
