WAC 182-08-199
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Agency filings affecting this section
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When may an employee enroll in or change his or her election under the premium payment plan, medical flexible spending arrangement (FSA) or dependent care assistance program (DCAP)?
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An eligible employee (as described in WAC
182-12-116) may enroll in or change his or her election under the premium payment plan, medical flexible spending arrangement (FSA), or dependent care assistance program (DCAP) at the following times:
(1) When they are newly eligible under WAC
182-12-114, as described in WAC
182-08-197.
(2)
During annual open enrollment: An eligible employee (as described in WAC
182-12-116) may enroll in or change their election under the state's premium payment plan, medical FSA or DCAP during the annual open enrollment. Employees must submit, in paper or online, the appropriate enrollment form to enroll or reenroll no later than the last day of the annual open enrollment. The enrollment or new election will be effective January 1st of the following year.
(3)
During a special open enrollment: Employees may enroll or change their election under the state's premium payment plan, medical FSA or DCAP outside of the annual open enrollment if a special open enrollment event occurs. The enrollment or change in enrollment must be allowable under Internal Revenue Code (IRC) and correspond to and be consistent with the event that creates the special open enrollment. To make a change or enroll, the employee must submit the appropriate forms as instructed on the forms no later than sixty days after the event occurs.
For purposes of this section, an eligible dependent includes any person who qualifies as a dependent of the employee for tax purposes under IRC Section 152 without regard to the income limitations of that section. It does not include a state registered domestic partner unless the domestic partner otherwise qualifies as a dependent for tax purposes under IRC Section 152.
(a)
Premium payment plan. An employee may enroll or change his or her election under the premium payment plan when any of the following special open enrollment events occur, if the requested change corresponds to and is consistent with the event. Enrollment will be effective the first day of the month following the later of the event date or the date the form is received.
(i) Employee acquires a new dependent due to:
Marriage;
Registering a domestic partnership when the dependent is a tax dependent of the subscriber;
Birth, adoption, or when the subscriber has assumed a legal obligation for total or partial support in anticipation of adoption;
A child becoming eligible as an extended dependent through legal custody or legal guardianship; or
A child becoming eligible as a dependent with a disability;
(ii) Employee's dependent no longer meets public employees benefits board (PEBB) eligibility criteria because:
Employee has a change in marital status;
Employee's domestic partnership with a domestic partner who is a tax dependent is dissolved or terminated;
An eligible dependent child turns age twenty-six or otherwise does not meet dependent child eligibility criteria;
An eligible dependent ceases to be eligible as an extended dependent or as a dependent with a disability; or
An eligible dependent dies.
(iii) Employee or an employee's dependent loses other coverage under a group health plan or through health insurance coverage, as defined by the Health Insurance Portability and Accountability Act (HIPAA);
(iv) Employee or an employee's dependent has a change in employment status that affects the employee's or a dependent's eligibility for the employer contribution toward group health coverage;
(v) Employee or an employee's dependent has a change in enrollment under another employer plan during its annual open enrollment that does not align with the PEBB program's annual open enrollment;
(vi) Employee or an employee's dependent has a change in residence that affects health plan availability;
(vii) Employee's dependent has a change in residence from outside of the United States to within the United States;
(viii) A court order or national medical support notice (see also WAC
182-12-263) requires the employee or any other individual to provide insurance coverage for an eligible dependent of the subscriber (a former spouse or former registered domestic partner is not an eligible dependent);
(ix) Employee or employee's dependent becomes eligible for state premium assistance through medicaid or a state children's health insurance program (CHIP), or the employee or employee's dependent loses eligibility for coverage under medicaid or CHIP;
(x) Employee or employee's dependent gains or loses eligibility for medicare;
(xi) Employee or employee's dependent's current health plan becomes unavailable because the employee or enrolled dependent is no longer eligible for a health savings account (HSA). The health care authority (HCA) may require evidence that the employee or employee's dependent is no longer eligible for an HSA;
(xii) Employee or employee's dependent experiences a disruption of care that could function as a reduction in benefits for the employee or the employee's dependent for a specific condition or ongoing course of treatment. The employee may not change their health plan election if the employee's or dependent's physician stops participation with the employee's health plan unless the PEBB program determines that a continuity of care issue exists. The PEBB program will consider but not limit its consideration to the following:
(A) Active cancer treatment such as chemotherapy or radiation therapy for up to ninety days or until medically stable; or
(B) Transplant within the last twelve months; or
(C) Scheduled surgery within the next sixty days (elective procedures within the next sixty days do not qualify for continuity of care); or
(D) Recent major surgery still within the postoperative period of up to eight weeks; or
(E) Third trimester of pregnancy.
If the employee is having premiums taken from payroll on a pretax basis, a plan change will not be approved if it would conflict with provisions of the salary reduction plan authorized under RCW
41.05.300.
(b)
Flexible spending account (FSA). An employee may enroll or change his or her election under the medical FSA when any one of the following special open enrollment events occur, if the requested change corresponds to and is consistent with the event. Enrollment will be effective the first day of the month following approval by the FSA administrator.
(i) Employee acquires a new dependent due to:
Marriage;
Registering a domestic partnership if the domestic partner qualifies as a tax dependent of the subscriber;
Birth, adoption, or when the subscriber has assumed a legal obligation for total or partial support in anticipation of adoption;
A child becoming eligible as an extended dependent through legal custody or legal guardianship; or
A child becoming eligible as a dependent with a disability.
(ii) Employee's dependent no longer meets PEBB eligibility criteria because:
Employee has a change in marital status;
Employee's domestic partnership with a domestic partner who qualifies as a tax dependent is dissolved or terminated;
An eligible dependent child turns age twenty-six or otherwise does not meet dependent child eligibility criteria;
An eligible dependent ceases to be eligible as an extended dependent or as a dependent with a disability; or
An eligible dependent dies.
(iii) Employee or an employee's dependent has a change in employment status that affects the employee's or a dependent's eligibility for the FSA;
(iv) A court order or national medical support notice requires the employee or any other individual to provide insurance coverage for an eligible dependent of the subscriber (a former spouse or former registered domestic partner is not an eligible dependent);
(v) Employee or an employee's dependent loses eligibility for coverage under medicaid or a state children's health insurance program (CHIP);
(vi) Employee or an employee's dependent gains or loses eligibility for medicare.
(c)
Dependent care assistance program (DCAP). An employee may enroll or change his or her election under the DCAP when any one of the following special open enrollment events occur, if the requested change corresponds to and is consistent with the event. Enrollment will be effective the first day of the month following approval by the DCAP administrator.
(i) Employee acquires a new dependent due to:
Marriage;
Registering a domestic partnership if the domestic partner qualifies as a tax dependent of the subscriber;
Birth, adoption, or when the subscriber has assumed a legal obligation for total or partial support in anticipation of adoption;
A child becoming eligible as an extended dependent through legal custody or legal guardianship; or
A child becoming eligible as a dependent with a disability.
(ii) Employee or an employee's dependent has a change in employment status that affects the employee's or a dependent's eligibility for DCAP;
(iii) Employee or an employee's dependent has a change in enrollment under another employer plan during its annual open enrollment that does not align with the PEBB program's annual open enrollment;
(iv) Employee changes dependent care provider; the change to DCAP can reflect the cost of the new provider;
(v) Employee or the employee's spouse experiences a change in the number of qualifying individuals as defined in IRC Section 21 (b)(1);
(vi) Employee's dependent care provider imposes a change in the cost of dependent care; employee may make a change in the DCAP to reflect the new cost if the dependent care provider is not a relative as defined in Section 152 (a)(1) through (8), incorporating the rules of Section 152 (b)(1) and (2) of the IRC.
[Statutory Authority: RCW 41.05.160. 12-20-022 (Order 2012-01), § 182-08-199, filed 9/25/12, effective 11/1/12. Statutory Authority: RCW 41.05.160 and 2011 c 8. 11-22-036 (Order 11-02), § 182-08-199, filed 10/26/11, effective 1/1/12. Statutory Authority: RCW 41.05.160. 10-20-147 (Order 10-02), § 182-08-199, filed 10/6/10, effective 1/1/11; 09-23-102 (Order 09-02), § 182-08-199, filed 11/17/09, effective 1/1/10; 08-20-128 (Order 08-03), § 182-08-199, filed 10/1/08, effective 1/1/09.]