PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form A (HCA51-4031)
for the current year.
Form A (HCA51-4031) Pebb Retiree Election Form - Washington
What Is Form A (HCA51-4031)?
This is a legal form that was released by the Washington State Health Care Authority - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form A (HCA51-4031)?
A: Form A (HCA51-4031) is the Pebb Retiree Election Form for retirees in Washington.
Q: Who can use Form A (HCA51-4031)?
A: Retirees in Washington can use Form A (HCA51-4031) to make their election choices.
Q: What is the purpose of Form A (HCA51-4031)?
A: The purpose of Form A (HCA51-4031) is to allow retirees to select their health coverage options.
Q: Are there any deadlines for submitting Form A (HCA51-4031)?
A: Yes, there are deadlines for submitting Form A (HCA51-4031). Please refer to the instructions provided with the form.
Q: Can I make changes to my election choices after submitting Form A (HCA51-4031)?
A: It depends on the specific rules and guidelines provided by the Washington State Health Care Authority. Please refer to the instructions and guidance for more information.
Q: What should I do if I have questions or need assistance with Form A (HCA51-4031)?
A: If you have questions or need assistance with Form A (HCA51-4031), you can contact the Washington State Health Care Authority for support.
Form Details:
- Released on October 1, 2021;
- The latest edition provided by the Washington State Health Care Authority;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form A (HCA51-4031) by clicking the link below or browse more documents and templates provided by the Washington State Health Care Authority.
Download Form A (HCA51-4031) Pebb Retiree Election Form - Washington
1
2
3
4
5
6
7
8
9
10
11
12
