(1)
Subscribers may enroll or waive eligible dependents when the subscriber becomes eligible and enrolls in PEBB insurance coverage. If enrolled, the dependent's effective date will be the same as the subscriber's effective date. Unless a dependent is independently eligible for PEBB health plan coverage, the subscriber must be enrolled to enroll their dependent.
| Exceptions: | • Adult dependents may enroll in a health plan if the employee has waived medical coverage or the retiree has deferred enrollment in PEBB retiree insurance in accordance with PEBB rule; |
| OR |
| • Eligible dependents of a retiree may enroll in a health plan if the retiree deferred PEBB retiree insurance coverage due to the retiree's enrollment in medicare and creditable medicaid under WAC 182-12-205 (1)(c). |
(2)
Subscribers may enroll eligible dependents during the annual open enrollment with health plan coverage beginning January of the following year.
(3)
Subscribers may enroll a newly acquired dependent or a dependent that becomes eligible during a special open enrollment. (a) A spouse may be enrolled upon marriage. If the date of marriage is the first day of the month, health plan coverage will begin on that date; otherwise, it will begin the first of the following month.
(b) A qualified domestic partner may be enrolled upon declaration or registration of the domestic partnership (see WAC
182-12-260). If the date of declaration or registration is the first day of the month, health plan coverage will begin on that date; otherwise, it will begin the first of the following month.
(c) Newborn children may be enrolled upon birth and adopted children may be enrolled when the subscriber assumes legal responsibility for the child in anticipation of adoption. The child's health plan coverage will begin on the date of birth or the date the subscriber assumes legal responsibility for the child in anticipation of adoption. The subscriber must submit the appropriate forms as described in subsection (7) of this section no later than sixty days after birth or assuming legal responsibility for the child.
(d) Children acquired through marriage or a qualified domestic partnership may be enrolled upon marriage or declaration or registration of the domestic partnership as described in (a) or (b) of this subsection.
(e) Extended dependents acquired through legal guardianship or legal custody (see WAC
182-12-260(4)) may be enrolled upon issuance of a court order granting such responsibility to the subscriber, spouse, or qualified domestic partner. If legal guardianship or legal custody begins on the first day of the month, health plan coverage will begin on that date; otherwise, it will begin the first of the following month.
(f) Children age twenty through age twenty-four (adult dependents) may be enrolled when they become eligible (see WAC
182-12-260 (4)(d)). If they become eligible on the first day of the month, health plan coverage will begin on that date; otherwise, it will begin the first of the month following the date they become eligible. For enrollment requirements, see subsection (7) of this section.
(g) Children who become eligible as students may be enrolled provided the child's eligibility is certified by the PEBB benefits services program. If enrolled, the child's insurance coverage will begin or continue on the first day of the month the child becomes eligible as a student according to WAC
182-12-260 (4)(c).
(h) A child twenty years or older who becomes eligible as a child with disabilities under WAC
182-12-260 (4)(e) may be enrolled after the child's eligibility is certified by the PEBB benefits services program.
Health plan coverage will begin on the first day of the month that eligibility is certified by the PEBB benefits services program.
(4)
Subscribers may change the enrollment (enroll, waive or remove) of their dependents outside of the annual open enrollment if a special open enrollment event occurs. The change in enrollment must correspond to the event that creates the special open enrollment for either the subscriber or the subscriber's dependents or both. Enrollment in health plan 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, health plan coverage will begin the month in which the event occurs. The following changes are events that create a special open enrollment for medical and dental:
(a) Subscriber acquires an eligible dependent through marriage, domestic partnership, birth, adoption or placement for adoption, legal custody or legal guardianship;
(b) Subscriber loses an eligible dependent or a dependent no longer meets PEBB eligibility criteria;
(c) Subscriber has a change in marital status, including legal separation documented by a court order;
(d) Subscriber or a dependent loses comprehensive group health insurance coverage;
(e) Subscriber or a dependent has a change in employment status that affects the subscriber's or a dependent's eligibility, level of benefits, or cost of insurance coverage;
(f) Subscriber or a dependent has a change in place of residence that affects the subscriber's or a dependent's eligibility, level of benefits, or cost of insurance coverage;
(g) Subscriber receives a court order or medical support enforcement order requiring the subscriber, their spouse, or qualified domestic partner to provide insurance coverage for an eligible dependent. (A former spouse is not an eligible dependent.);
(h) Subscriber receives formal notice that the department of social and health services has determined it is more cost-effective to enroll an eligible dependent in PEBB medical than a medical assistance program.
(5)
Subscribers may waive (interrupt or postpone) enrollment of an eligible dependent. (a) Employees may only waive dependents if those dependents are enrolled in another comprehensive group health plan. Employees may only waive an eligible dependent's enrollment at the following times:
(i) When the employee is first eligible and enrolls in PEBB benefits. (The dependent's enrollment will be waived beginning with the employee's effective date.);
(ii) During the annual open enrollment. (The dependent's enrollment will be waived beginning January of the following year.);
(iii) No later than sixty days after the dependent becomes eligible as described in subsection (3) of this section. (The dependent's enrollment will be waived beginning the date enrollment would have begun.); or
(iv) During a special open enrollment as described in subsection (4) of this section. (The dependent's enrollment will be waived as of the date corresponding to the event that creates the special open enrollment.)
(b) Retirees, survivors or individuals continuing PEBB insurance coverage under WAC
182-12-133 or
182-12-270 may waive enrollment of an eligible dependent outside of the annual open enrollment or a special open enrollment. Unless otherwise approved by the PEBB benefits services program, enrollment will be waived prospectively.
(c) Subscribers may enroll eligible dependents that were waived as stated in subsections (2) and (4) of this section.
(6)
Subscribers must remove dependents from the subscriber's insurance coverage within sixty days of the date the dependent no longer meets eligibility criteria in WAC
182-12-250 or
182-12-260. Insurance coverage enrollment ends the last day of the month in which the dependent is eligible.
Subscribers may remove a lawful spouse from PEBB insurance coverage in the event of legal separation documented by a court order, provided the court did not order the subscriber to maintain the spouse's health plan enrollment. Subscribers must remove former spouses and former qualified domestic partners upon finalization of a divorce, annulment, or termination of a partnership, even if a court order requires the subscriber to provide health insurance for the former spouse or partner.
Consequences for not submitting notice as described in subsection (7) of this section within sixty days of any dependent ceasing to be eligible may include:
(a) The dependent's loss of eligibility to continue health plan enrollment under one of the continuation options described in WAC
182-12-270;
(b) The subscriber being billed for claims paid by the health plan for services after the dependent lost eligibility; and
(c) The subscriber being responsible for premiums paid by the state for the dependent's health plan enrollment after the dependent lost eligibility.
(7)
Subscribers must submit the appropriate forms within the time frames described in this subsection. Employees submit the appropriate forms to their employing agency. All other subscribers submit the appropriate forms to the PEBB benefits services program. In addition to the appropriate forms indicating dependent enrollment, the PEBB benefits services program may require the subscriber to provide evidence of eligibility or evidence of the event that created the special open enrollment.
(a) If a subscriber wants to enroll their eligible dependent(s) when the subscriber becomes eligible to enroll in PEBB benefits, the subscriber must include the dependent's enrollment information on the appropriate forms that the subscriber submits within the relevant time frame described in WAC
182-08-197,
182-12-171, or
182-12-250.
(b) If a subscriber wants to enroll eligible dependents during the annual open enrollment, the subscriber must submit the appropriate forms no later than the end of the annual open enrollment.
(c) If a subscriber wants to enroll newly eligible dependents, the subscriber must submit the appropriate enrollment forms no later than sixty days after the dependent becomes eligible.
(d) If the subscriber wants to enroll a child age twenty or older as a child with disabilities, the subscriber must submit the appropriate enrollment form(s) required to certify the dependent's eligibility within the relevant time frame described in WAC
182-12-250(3) or 182-12-260(4).
(e) If the subscriber wants to change a dependent's enrollment status during a special open enrollment, the subscriber must submit the appropriate forms no later than sixty days after the event that creates the special open enrollment.
(f) If the subscriber wants to waive a dependent's enrollment, the subscriber must submit the appropriate forms. Unless otherwise approved by the PEBB benefits services program, enrollment will be waived prospectively.
[Statutory Authority: RCW 41.05.160. 08-20-128 (Order 08-03), § 182-12-262, filed 10/1/08, effective 1/1/09; 08-09-027 (Order 08-01), § 182-12-262, filed 4/8/08, effective 4/9/08.]