WSR 17-24-117

POLICY STATEMENT

[Filed December 6, 2017, 9:18 a.m.]

The following is a list of administrative policies published by the public employees benefits board (PEBB) program. These policies are effective January 1, 2018. You can download the complete policy statements at www.hca.wa.gov/public-employee-benefits/rules-and-policies.

The following policies were amended:

Policy 15-1: Determining eligibility for seasonal employees and maintenance of employer contribution through the off-season. This policy clarifies seasonal employee eligibility for PEBB benefits and the employer contribution.

Policy 17-2: Determining faculty eligibility after a layoff. Applying the criteria for maintaining the employer contribution toward insurance coverage for faculty following a layoff.

Policy 17-3: Determining faculty eligibility for off-quarter/semester or for decreases in workload. To clarify when a faculty member qualifies for the employer contribution toward insurance coverage during an off-quarter/semester or when there is a decrease in workload.

Policy 19-1: Termination due to loss of eligibility. This policy applies whenever coverage for a subscriber or a subscriber's dependent is terminated due to loss of eligibility.

Addendum 19-1A: Termination due to loss of eligibility. Employee.

Addendum 19-1B: Termination due to loss of eligibility. Self-pay subscriber.

Policy 21-1: Exemption from the retiree deferral form requirement. This policy exempts certain retirees from the "deferral form requirement" under WAC 182-12-171 (1)(c) and 182-12-205(3).

Policy 36-1: Certifying eligibility for a dependent child with a disability who is age twenty-six or older. This policy applies whenever a subscriber requests to enroll a dependent child with a disability who is age twenty-six or older to his or her PEBB program subscriber account.

Policy 45-2: Special Open Enrollment (SOE). This policy applies whenever a subscriber requests an enrollment change or election change outside of the PEBB program annual open enrollment period.

Addendum 45-2A: Special Open Enrollment (SOE) matrix. Summary of permitted election changes.

Policy 93-1: PEBB program premium payment, premium surcharge collection, and write-off. This policy outlines the criteria used by PEBB insurance accounting to determine when a premium payment or premium surcharge owed on a subscriber's account will be deemed uncollectable and subsequently written off.

The following policies are new:

Policy 56-1: Continuation coverage and retiree insurance coverage reinstatement for subscribers with mental impairment or physical incapacitation. This policy applies whenever a subscriber (or another party on behalf of the subscriber) requests reinstatement of continuation coverage or retiree insurance coverage due to nonpayment of premiums, or any applicable premium surcharges, for reason of mental impairment or physical incapacitation.

This policy (56-1) establishes the methodology that the PEBB program will use to make a determination of mental impairment or physical incapacitation and the timing requirements to request a reinstatement.

Policy 56-2: Continuation coverage and retiree insurance coverage election period tolling for applicants with mental impairment or physical incapacitation. This policy applies whenever an applicant (or another party on behalf of the applicant) requests tolling of the continuation coverage or retiree insurance coverage election period for reason of mental impairment or physical incapacitation.

This policy (56-2) establishes the methodology that the PEBB program will use to make a determination of mental impairment or physical incapacitation and the timing requirements to request tolling.

Policy 60-1: Required appeals related documents when the PEBB program is hearing an appeal. This policy clarifies what appeals related documents are required from an employing agency or third-party administrator when the PEBB program is hearing an appeal from one of its employees or subscribers.

Policy 90-2: What authority do employer groups or charter schools need before contracting with the PEBB program for health care benefits? This policy clarifies what authority is required from employer groups or charter schools as part of the application process for benefits with the health care authority (HCA) and the PEBB program.

Policy 90-3: Determining if an employer group or charter school requesting eligibility standards different from PEBB program rules shall be approved. This policy clarifies the criteria used by HCA to approve or deny requests for eligibility standards that are different eligibility standards than standards used by the PEBB program.

Policy 91-3: Washington wellness worksite designation program incentive requirements. This policy provides a set of requirements for state agencies to use when offering wellness incentives under the Washington wellness worksite designation program.

The following policies were amended to update the structure with no material changes:

To receive a hard copy of the policy statements, contact Rob Parkman at P.O. Box 42684, [Olympia,] WA 98501-2684, or 360-725-0883.