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182-08-198  <<  182-08-199 >>   182-08-200

(Effective until January 1, 2015.)

WAC 182-08-199

Agency filings affecting this section

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)?

An employee who is eligible to participate in the state's salary reduction plan 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 newly eligible under WAC 182-12-114, as described in WAC 182-08-197(1).
(2) During annual open enrollment: An eligible employee may enroll in or change his or her election under the state's premium payment plan, medical FSA or DCAP during the annual open enrollment. The employee must submit, in paper or online, the required 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: An employee may enroll or change his or her 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 election 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 required enrollment forms as instructed on the forms no later than sixty days after the event occurs. The employee must provide evidence of the event that created the special open enrollment.
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. The enrollment or change in election will be effective the first day of the month following the later of the event date or the date the form is received. If that day is the first of the month, the enrollment or change in election begins on that day. If the special open enrollment is due to the birth, adoption or assumption of legal obligation for total or partial support in anticipation of adoption of a child, the enrollment or change in election will begin the first of the month in which the event occurs.
(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 their 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 an employee's dependent becomes entitled to coverage under medicaid or a state children's health insurance program (CHIP), or the subscriber or a subscriber's dependent loses eligibility for coverage under medicaid or CHIP;
(x) Employee or an employee's dependent becomes eligible for state premium assistance subsidy for PEBB health plan coverage from medicaid or a state children's health insurance program (CHIP);
(xi) Employee or an employee's dependent becomes entitled to coverage under medicare, or the employee or an employee's dependent loses eligibility for coverage under medicare, or enrolls in or cancels enrollment in a medicare Part D plan;
(xii) Employee or an 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;
(xiii) Employee has a change in the cost of insurance coverage because of a premium surcharge;
(xiv) Employee or an 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:
• Active cancer treatment such as chemotherapy or radiation therapy for up to ninety days or until medically stable; or
• Transplant within the last twelve months; or
• Scheduled surgery within the next sixty days (elective procedures within the next sixty days do not qualify for continuity of care); or
• Recent major surgery still within the postoperative period of up to eight weeks; or
• 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. The enrollment or change in election 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 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 FSA;
(v) 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);
(vi) Employee or an employee's dependent becomes entitled to coverage under medicaid or a state children's health insurance program (CHIP), or the employee or an employee's dependent loses eligibility for coverage under medicaid or CHIP;
(vii) Employee or an employee's dependent becomes entitled to coverage under 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. The enrollment or change in election 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 (d)(1) through (5), incorporating the rules of Section 152 (b)(1) through (3) of the IRC.
(4) During the premium surcharge implementation period: An eligible employee may enroll in or change his or her election under the state's premium payment plan from April 1 through May 15, 2014. The employee must submit, in paper or online, the required enrollment form to enroll or change his or her election no later than May 15, 2014. The enrollment or change in election will begin July 1, 2014.
[Statutory Authority: RCW 41.05.160, 2013 2nd sp.s. c 4 and PEBB policy resolutions. WSR 14-08-040, § 182-08-199, filed 3/26/14, effective 4/26/14. Statutory Authority: RCW 41.05.160 and 2012 2nd sp.s. c 3. WSR 13-22-019 (Admin. 2013-01), § 182-08-199, filed 10/28/13, effective 1/1/14. Statutory Authority: RCW 41.05.160. WSR 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. WSR 11-22-036 (Order 11-02), § 182-08-199, filed 10/26/11, effective 1/1/12. Statutory Authority: RCW 41.05.160. WSR 10-20-147 (Order 10-02), § 182-08-199, filed 10/6/10, effective 1/1/11; WSR 09-23-102 (Order 09-02), § 182-08-199, filed 11/17/09, effective 1/1/10; WSR 08-20-128 (Order 08-03), § 182-08-199, filed 10/1/08, effective 1/1/09.]
(Effective January 1, 2015.)

WAC 182-08-199

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)?

An employee who is eligible to participate in the state's salary reduction plan 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 newly eligible under WAC 182-12-114, as described in WAC 182-08-197(1).
(2) During annual open enrollment: An eligible employee may enroll in or change his or her election under the state's premium payment plan, medical FSA or DCAP during the annual open enrollment. For the state's premium payment plan, the required enrollment form must be submitted to his or her employing agency. To enroll or reenroll in medical FSA or DCAP the employee must submit the required enrollment form to his or her employing agency or public employees benefits board (PEBB) designee. All required forms must be received 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: An employee may enroll or change his or her 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 election 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 required enrollment forms as instructed on the forms. The required enrollment forms must be received no later than sixty days after the event occurs. The employee must provide evidence of the event that created the special open enrollment.
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 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. The enrollment or change in election will be effective the first day of the month following the later of the event date or the date the form is received. If that day is the first of the month, the enrollment or change in election begins on that day. If the special open enrollment is due to the birth, adoption or assumption of legal obligation for total or partial support in anticipation of adoption of a child, the enrollment or change in election will begin the first of the month in which the event occurs.
(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 PEBB eligibility criteria because:
• Employee has a change in marital status;
• Employee's domestic partnership with a registered 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 their employer contribution toward employer-based group health insurance;
(v) Employee or an employee's dependent has a change in enrollment under another employer-based group health insurance 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, or from within the United States to outside of 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 an employee's dependent becomes entitled to coverage under medicaid or a state children's health insurance program (CHIP), or the subscriber or a subscriber's dependent loses eligibility for coverage under medicaid or CHIP;
(x) Employee or an employee's dependent becomes eligible for state premium assistance subsidy for PEBB health plan coverage from medicaid or a state children's health insurance program (CHIP);
(xi) Employee or an employee's dependent becomes entitled to coverage under medicare, or the employee or an employee's dependent loses eligibility for coverage under medicare, or enrolls in or cancels enrollment in a medicare Part D plan;
(xii) Employee or an 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;
(xiii) Employee or an 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:
• Active cancer treatment such as chemotherapy or radiation therapy for up to ninety days or until medically stable; or
• Transplant within the last twelve months; or
• Scheduled surgery within the next sixty days (elective procedures within the next sixty days do not qualify for continuity of care); or
• Recent major surgery still within the postoperative period of up to eight weeks; or
• 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. The enrollment or change in election will be effective the first day of the month following the later of the event date or the date the form is received. If that day is the first of the month, the enrollment or change in election begins on that day. If the special open enrollment is due to the birth, adoption or assumption of legal obligation for total or partial support in anticipation of adoption of a child, the enrollment or change in election will begin the first of the month in which the event occurs.
(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 registered 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 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 FSA;
(v) 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);
(vi) Employee or an employee's dependent becomes entitled to coverage under medicaid or a state children's health insurance program (CHIP), or the employee or an employee's dependent loses eligibility for coverage under medicaid or CHIP;
(vii) Employee or an employee's dependent becomes entitled to coverage under 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. The enrollment or change in election will be effective the first day of the month following the later of the event date or the date the form is received. If that day is the first of the month, the enrollment or change in election begins on that day. If the special open enrollment is due to the birth, adoption or assumption of legal obligation for total or partial support in anticipation of adoption of a child, the enrollment or change in election will begin the first of the month in which the event occurs.
(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-based group health insurance 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 (d)(1) through (5), incorporating the rules of Section 152 (b)(1) through (3) of the IRC.
[Statutory Authority: RCW 41.05.160 and 2013 2nd sp.s. c 4. WSR 14-20-058 (PEBB Admin 2014-02), § 182-08-199, filed 9/25/14, effective 1/1/15. Statutory Authority: RCW 41.05.160, 2013 2nd sp.s. c 4 and PEBB policy resolutions. WSR 14-08-040, § 182-08-199, filed 3/26/14, effective 4/26/14. Statutory Authority: RCW 41.05.160 and 2012 2nd sp.s. c 3. WSR 13-22-019 (Admin. 2013-01), § 182-08-199, filed 10/28/13, effective 1/1/14. Statutory Authority: RCW 41.05.160. WSR 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. WSR 11-22-036 (Order 11-02), § 182-08-199, filed 10/26/11, effective 1/1/12. Statutory Authority: RCW 41.05.160. WSR 10-20-147 (Order 10-02), § 182-08-199, filed 10/6/10, effective 1/1/11; WSR 09-23-102 (Order 09-02), § 182-08-199, filed 11/17/09, effective 1/1/10; WSR 08-20-128 (Order 08-03), § 182-08-199, filed 10/1/08, effective 1/1/09.]