Complete this form if you want to add coverage(s), make changes, or cancel your coverage(s) for the 2021 plan year. This form is used for "combination coverage" only. Combination coverage applies when you are covering your spouse and/or child(ren) and one of you is on Medicare, but others are still under age 65.
For enrollments effective in 2021. This form allows you to enroll in or change your PERACare coverage if you are in Medicare. You may also complete the PERACare Medicare Enrollment/Change Form online in our secure area. (Requires a PERA PIN/User ID and password.)
For enrollments effective in 2021. This form allows you to enroll in or change your PERACare coverage if you are pre-Medicare. You may also complete the PERACare Pre-Medicare Enrollment/Change Form online in our secure area. (Requires a PERA PIN/User ID and password.)
For enrollments effective in 2021. This booklet provides details about PERACare, PERA's health benefits program, for benefit recipients (and eligible dependents) in Medicare. To enroll or change coverage, you will need to complete the PERACare Medicare Enrollment/Change Form.
For enrollments effective in 2021. This booklet provides details about PERACare, PERA's health benefits program, for benefit recipients (and eligible dependents) who are under age 65 and not in Medicare. To enroll or change coverage, you will need to complete the PERACare Pre-Medicare Enrollment/Change Form. (Unless you specify otherwise, this booklet will be included in your Retirement Kit.)
For enrollments effective in 2021. This open enrollment guide provides a summary about PERACare plans available for benefit recipients (and eligible dependents) in Medicare and how to enroll during the open enrollment period. To enroll or change coverage, you will need to complete an Enrollment/Change Form.
For enrollments effective in 2021. This open enrollment guide provides a summary about PERACare plans available for benefit recipients (and eligible dependents) who are under age 65 and not in Medicare and how to enroll during the open enrollment period. To enroll or change coverage, you will need to complete an Enrollment/Change Form.
Complete this form if you want to add coverage(s), make changes, or cancel your coverage(s) for the 2022 plan year. This form is used for "combination coverage" only. Combination coverage applies when you are covering your spouse and/or child(ren) and one of you is on Medicare, but others are still under age 65.
For enrollments effective in 2022. This form allows you to enroll in or change your PERACare coverage if you are in Medicare. You may also complete the PERACare Medicare Enrollment/Change Form online in our secure area. (Requires a PERA PIN/User ID and password.)
