Employees must enroll in dental, life and long-term disability insurance (unless the employing agency does not participate in these PEBB insurance coverages). However, employees may waive PEBB medical if they have other comprehensive group medical coverage.
(1) Employees may waive enrollment in PEBB medical by submitting the appropriate enrollment form to their employing agency during the following times:
(a)
When the employee becomes eligible: Employees may waive medical when they become eligible for PEBB benefits. Employees must indicate they are waiving medical on the appropriate enrollment form they submit to their employing agency no later than thirty-one days after the date they become eligible (see WAC
182-08-197). Medical will be waived as of the date the employee becomes eligible for PEBB benefits.
(b)
During the annual open enrollment: Employees may waive medical during the annual open enrollment if they submit the appropriate enrollment form to their employing agency before the end of the annual open enrollment. Medical will be waived beginning January 1st of the following year.
(c)
During a special open enrollment: Employees may waive medical during a special open enrollment as described in subsection (4) of this section.
(2) If an employee waives medical, the employee's eligible dependents may not be enrolled in medical, with the exception of adult dependents who may enroll in a health plan if the employee has waived medical coverage.
(3) Once medical is waived, enrollment is only allowed during the following times:
(a) During the annual open enrollment;
(b) During a special open enrollment created by an event that allows for enrollment outside of the annual open enrollment as described in subsection (4) of this section. In addition to the appropriate forms, the PEBB program may require the employee to provide evidence of eligibility and evidence of the event that creates a special open enrollment.
(4)
Special open enrollment: Employees may waive enrollment in medical or enroll in medical if one of these special open enrollment events occur. The change in enrollment must correspond to the event that creates the special open enrollment. The following changes are events that create a special open enrollment:
(a) Employee acquires a new eligible dependent through marriage, registering a domestic partnership with Washington state, birth, adoption or when the subscriber has assumed a legal obligation for total or partial support in anticipation of adoption, legal custody or legal guardianship;
(b) Employee's dependent child becomes eligible by fulfilling PEBB dependent eligibility criteria;
(c) Employee loses an eligible dependent or a dependent no longer meets PEBB eligibility criteria;
(d) Employee has a change in marital status or Washington state registered domestic partnership status, including legal separation documented by a court order;
(e) Employee or a dependent loses comprehensive group insurance coverage;
(f) Employee or a dependent has a change in employment status that affects the employee's or a dependent's eligibility, level of benefits, or cost of insurance coverage;
(g) Employee or a dependent has a change in place of residence that affects the employee's or a dependent's eligibility, level of benefits, or cost of insurance coverage;
(h) Employee receives a court order or medical support enforcement order requiring the employee, spouse, or qualified domestic partner to enroll an eligible dependent;
(i) Employee or dependent becomes eligible for a medical assistance program under the department of social and health services, including medicaid or the children's health insurance program (CHIP), or the employee or dependent loses eligibility in a medical assistance program.
To waive or enroll during a special open enrollment, the employee must submit the appropriate forms to their employing agency no later than sixty days after the event that creates the special open enrollment.
Enrollment in insurance coverage will begin the first of the month following the event that created the special open enrollment; or in cases where the event occurs on the first day of a month, enrollment will begin on that date. If the special open enrollment is due to the birth or adoption of a child, insurance coverage will begin the month in which the event occurs.
[Statutory Authority: RCW 41.05.160. 09-23-102 (Order 09-02), § 182-12-128, filed 11/17/09, effective 1/1/10; 08-20-128 (Order 08-03), § 182-12-128, filed 10/1/08, effective 1/1/09; 08-09-027 (Order 08-01), § 182-12-128, filed 4/8/08, effective 4/9/08; 07-20-129 (Order 07-01), § 182-12-128, filed 10/3/07, effective 11/3/07. Statutory Authority: RCW 41.05.160 and 41.05.165. 04-18-039, § 182-12-128, filed 8/26/04, effective 1/1/05.]