The following entities and individuals shall be eligible for public employees benefits board (PEBB) insurance coverage subject to the terms and conditions set forth below:
(1) State agencies. State agencies, as defined in WAC 182-12-109
, are required to participate in all PEBB benefits. Insurance and health care contributions for ferry employees shall be governed by RCW 47.64.270
(2) Employer groups. Employer groups may apply to participate in PEBB insurance coverage for groups of employees described in subsection (a) of this section at the option of each employer group:
(a) All eligible employees of the entity must transfer as a unit with the following exceptions:
• Bargaining units may elect to participate separately from the whole group;
• Nonrepresented employees may elect to participate separately from the whole group provided all nonrepresented employees join as a group; and
• Members of the employer group's governing authority may participate as defined in the employer group's governing statutes and RCW 41.04.205
(b) The employer group must apply through the process described in WAC 182-08-235
. K-12 school district and educational service district applications do not have to include the census information required in WAC 182-08-235
(4) or (5). Employer group applications are subject to review and approval by the health care authority (HCA). With the exception of K-12 school districts and educational service districts, the authority will approve or deny an employer group's application based on the employer group eligibility criteria described in WAC 182-08-240
(c) Employer groups participate through a contract with the authority as described in WAC 182-08-245
(3) School districts and educational service districts. In addition to subsection (2) of this section, the following applies to school districts and educational service districts:
(a) The HCA will collect an amount equal to the composite rate charged to state agencies plus an amount equal to the employee premium by health plan and family size as would be charged to state employees for each participating school district or educational service district.
(b) The HCA may collect these amounts in accordance with the district fiscal year, as described in RCW 28A.505.030
(4) The Washington health benefit exchange. In addition to subsection (2) of this section, the following provisions apply:
(a) The Washington health benefit exchange is subject to the same rules as an employing agency in chapters182-08
(b) An employee of the Washington health benefit exchange is subject to the same rules as an employee of an employing agency in chapters182-08
(5) Eligible nonemployees.
(a) Blind vendors means a "licensee" as defined in RCW 74.18.200
: Vendors actively operating a business enterprise program facility in the state of Washington and deemed eligible by the department of services for the blind may voluntarily participate in PEBB insurance coverage.
(i) Vendors that do not enroll when first eligible may enroll only during the annual open enrollment period offered by the HCA or the first day of the month following loss of other insurance coverage.
(ii) Department of services for the blind will notify eligible vendors of their eligibility in advance of the date that they are eligible to apply for enrollment in PEBB insurance coverage.
(iii) The eligibility requirements for dependents of blind vendors shall be the same as the requirements for dependents of the state employees in WAC 182-12-260
(b) Dislocated forest products workers enrolled in the employment and career orientation program pursuant to chapter 50.70
RCW shall be eligible for PEBB health plans while enrolled in that program.
(c) School board members or students eligible to participate under RCW 28A.400.350
may participate in PEBB insurance coverage as long as they remain eligible under that section.
(6) Individuals that are not eligible include:
(a) Adult family home providers as defined in RCW 70.128.010
(b) Unpaid volunteers;
(c) Patients of state hospitals;
(e) Employees of the Washington state convention and trade center as provided in RCW 41.05.110
(f) Students of institutions of higher education as determined by their institutions; and
(g) Any others not expressly defined as employees under RCW 41.05.011
[Statutory Authority: RCW 41.05.160. 12-20-022 (Order 2012-01), § 182-12-111, filed 9/25/12, effective 11/1/12; 10-20-147 (Order 10-02), § 182-12-111, filed 10/6/10, effective 1/1/11; 09-23-102 (Order 09-02), § 182-12-111, filed 11/17/09, effective 1/1/10; 08-20-128 (Order 08-03), § 182-12-111, filed 10/1/08, effective 1/1/09; 07-20-129 (Order 07-01), § 182-12-111, filed 10/3/07, effective 11/3/07. Statutory Authority: RCW 41.05.160 and 41.05.165. 04-18-039, § 182-12-111, filed 8/26/04, effective 1/1/05; 03-17-031 (Order 02-07), § 182-12-111, filed 8/14/03, effective 9/14/03. Statutory Authority: RCW 41.05.160. 02-18-087 (Order 02-02), § 182-12-111, filed 9/3/02, effective 10/4/02; 99-19-028 (Order 99-04), § 182-12-111, filed 9/8/99, effective 10/9/99; 97-21-127, § 182-12-111, filed 10/21/97, effective 11/21/97. Statutory Authority: Chapter 41.05 RCW. 96-08-043, § 182-12-111, filed 3/29/96, effective 4/29/96. Statutory Authority: RCW 41.04.205, 41.05.065, 41.05.011, 41.05.080 and chapter 41.05 RCW. 92-03-040, § 182-12-111, filed 1/10/92, effective 1/10/92. Statutory Authority: Chapter 41.05 RCW. 78-02-015 (Order 2-78), § 182-12-111, filed 1/10/78.]