(1) Enrolling dependents in health plan coverage.
A dependent must be enrolled in the same health plan coverage as the subscriber, and the subscriber must be enrolled to enroll his or her dependent except as provided in WAC 182-12-205
(1)(c). Subscribers may enroll eligible dependents at the following times:
(a) When the subscriber becomes eligible
and enrolls in public employees benefits board (PEBB) insurance coverage. If eligibility is verified and the dependent is enrolled, the dependent's effective date will be the same as the subscriber's effective date.
(b) During the annual open enrollment.
PEBB health plan coverage begins January 1st of the following year.
(c) During special open enrollment.
Subscribers may enroll dependents during a special open enrollment as described in subsection (3) of this section. The subscriber must satisfy the enrollment requirements as described in subsection (4) of this section.
(2) Removing dependents from a subscriber's health plan coverage.
(a) A dependent's eligibility for enrollment in health plan coverage ends the last day of the month the dependent
meets the eligibility criteria in WAC 182-12-250
. Employees must notify their employing agency. All other subscribers must notify the PEBB program. Consequences for not submitting notice within sixty days of any dependent ceasing to be eligible may include, but are not limited to:
(i) The dependent may lose eligibility to continue health plan coverage under one of the continuation coverage options described in WAC 182-12-270
(ii) The subscriber may be billed for claims paid by the health plan for services that were rendered after the dependent lost eligibility;
(iii) The subscriber may not be able to recover subscriber-paid insurance premiums for dependents that lost their eligibility; and
(iv) The subscriber may be responsible for premiums paid by the state for the dependent's health plan coverage after the dependent lost eligibility.
(b) Employees have the opportunity to remove dependents:
(i) During the annual open enrollment. The dependent will be removed the last day of December; or
(ii) During a special open enrollment as described in subsections (3) and (4)(f) of this section.
(c) Retirees, survivors, and enrollees with PEBB continuation coverage under WAC 182-12-133, 182-12-141, 182-12-142, 182-12-146, or 182-12-148 may remove dependents
from their coverage outside of the annual open enrollment or a special open enrollment by providing written notice to the PEBB program. Unless otherwise approved by the PEBB program, the dependent will be removed from the subscriber's coverage prospectively.
(3) Special open enrollment.
Subscribers may enroll or remove 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, the subscriber's dependents or both.
• Health plan coverage will begin the first of the month following the later of the event date or the date the form is received.
• Enrollment of extended dependents or dependents with a disability will be the first day of the month following eligibility certification.
• Dependents will be removed from the subscriber's health plan coverage the last day of the month following the later of the event date or the date the form is received.
• If the special open enrollment is due to the birth or adoption of a child, or when the subscriber has assumed a legal obligation for total or partial support in anticipation of adoption of a child, health plan coverage will begin or end the month in which the event occurs.
Any one of the following events may create a special open enrollment:
(a) Subscriber acquires a new dependent due to:
(i) Marriage or registering a domestic partnership;
(ii) Birth, adoption, or when a subscriber has assumed a legal obligation for total or partial support in anticipation of adoption;
(iii) A child becoming eligible as an extended dependent through legal custody or legal guardianship; or
(iv) A child becoming eligible as a dependent with a disability;
(b) Subscriber or a subscriber'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);
(c) Subscriber or a subscriber's dependent has a change in employment status that affects the subscriber's or the subscriber's dependent's eligibility for the employer contribution toward group health coverage;
(d) Subscriber or subscriber'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;
(e) Subscriber's dependent has a change in residence from outside of the United States to within the United States;
(f) A court order or national medical support notice (see also WAC 182-12-263
) requires the subscriber 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);
(g) Subscriber or a subscriber's dependent becomes eligible for state premium assistance through medicaid or a state children's health insurance program (CHIP), or the subscriber or dependent loses eligibility for coverage under medicaid or CHIP.
(4) Enrollment requirements. 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 program. In addition to the appropriate forms indicating dependent enrollment, the subscriber must provide the required documents as evidence of the dependent's eligibility; or as 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
, 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 last day 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 except as provided in (d) of this subsection.
(d) If a subscriber wants to enroll a newborn or child whom the subscriber has adopted or has assumed a legal obligation for total or partial support in anticipation of adoption, the subscriber should notify the PEBB program by submitting an enrollment form as soon as possible to ensure timely payment of claims. If adding the child increases the premium, the subscriber must submit the appropriate enrollment form no later than twelve months after the date of the birth, adoption, or the date the legal obligation is assumed for total or partial support in anticipation of adoption.
(e) If the subscriber wants to enroll a child age twenty-six or older as a child with a disability, the subscriber must submit the appropriate form(s) no later than sixty days after the last day of the month in which the child reaches age twenty-six or within the relevant time frame described in WAC 182-12-262
(4)(a), (b), and (f).
(f) 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.
[Statutory Authority: RCW 41.05.160. 12-20-022 (Order 2012-01), § 182-12-262, filed 9/25/12, effective 11/1/12. Statutory Authority: RCW 41.05.160 and 2011 c 8. 11-22-036 (Order 11-02), § 182-12-262, filed 10/26/11, effective 1/1/12. Statutory Authority: RCW 41.05.160. 10-20-147 (Order 10-02), § 182-12-262, filed 10/6/10, effective 1/1/11; 09-23-102 (Order 09-02), § 182-12-262, filed 11/17/09, effective 1/1/10; 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.]