Program (REHP) provides health benefits to retirees. The below-referenced member is enrolled in REHP non-Medicare health benefits as a spouse of an REHP retiree member. For retirees, who as active employees, were hired on or after August 1, 2003, REHP eligibility rules require that the spouse must take their own employer s health benefit coverage (as an employee or retiree) even if they have to pay for the coverage or if the employer offers an incentive to decline the coverage. The spouse mus.
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How to fill out the PA PEBTF-36 online
This guide provides a clear and supportive pathway for completing the PA PEBTF-36 form online, ensuring that users understand each section and field. Follow these steps to correctly fill out the Employer Benefit Verification Form.
Follow the steps to complete the PA PEBTF-36 form online.
- Click the ‘Get Form’ button to access the PA PEBTF-36, and open it in your preferred editing tool.
- Begin by completing the section titled 'To be completed by the REHP retiree member.' Enter the Commonwealth retiree's name, last 4 digits of their Social Security Number, and their date of birth in the specified format (mm/dd/yyyy).
- Provide the spouse’s name and date of birth in the designated sections (mm/dd/yyyy).
- Indicate your spouse’s employment status by selecting either 'Full-Time', 'Part-Time', or 'No' in response to the question 'My spouse is employed.'
- Respond to the question 'My spouse is retired' by marking 'Yes' or 'No'. Ensure that you sign and date this section as required.
- The next section is 'To be completed by an authorized representative of the spouse’s employer.' Enter the company name and address.
- Answer whether the spouse is eligible for health insurance. If 'Yes', indicate the date they became eligible.
- Specify if the spouse is currently enrolled in their company’s health insurance plan. If applicable, provide dates regarding eligibility and enrollment.
- Fill in the employer representative's printed name, their title, and ensure they sign and date the form. Collect their telephone number as well.
- After completing all sections, review the form for accuracy. Save any changes made, then download or print a copy for your records.
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What does the Pebtf stand for?
The Pennsylvania Employees Benefit Trust Fund (PEBTF), established in 1988, administers health care benefits to approximately 68,000 eligible Commonwealth of Pennsylvania employees and their dependents and 65,000 retirees and their dependents, as well as additional employer groups.
What benefits do PA state employees get?
Regardless of which health plan you choose, you will receive: Behavioral and mental health counseling, prescription drug, dental, vision, and hearing aid benefits. Free life insurance of 1x salary to a maximum of $40,000, and additional life insurance may be purchased at competitive rates.
What is the employee benefit trust of Eastern PA?
Welcome to Employee Benefit Trust of Eastern Pennsylvania, or EBTEP as it is commonly known to most employees. EBTEP was created in 1983 to provide affordable, cost-saving and quality heath care benefits to public school system employees and their dependents.
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