Current through Register Vol. 24-18, September 15, 2024
Public employees benefits board (PEBB) insurance coverage
premiums and applicable premium surcharges for all subscribers are due as
described in this section, except when an employing agency is correcting its
enrollment error as described in WAC
182-08-187 (4) or
(5).
(1)
Premium payments. PEBB
insurance coverage premiums and applicable premium surcharges for all
subscribers become due the first of the month in which PEBB insurance coverage
is effective.
Premiums and applicable premium surcharges are due from the
subscriber for the entire month of PEBB insurance coverage and will not be
prorated during any month, except as described in (e) of this
subsection.
(a) For subscribers not
eligible for the employer contribution that are electing to enroll in PEBB
retiree insurance coverage as described in WAC
182-12-171
(1)(a),
182-12-180(3)(a),
182-12-200 (3)(a) or
(b),
182-12-205 (6) or
(7),
182-12-211, and
182-12-265 (1), (2)(d), and
(3); or electing to enroll in continuation
coverage as described in WAC
182-12-133,
182-12-141,
182-12-142,
182-12-146,
182-12-148, and
182-12-270; or a retired
employee, a retired school employee, or a survivor electing to enroll in PEBB
health plan coverage when their employer group ceases participation as
described in WAC 182-12-232, the first premium payment and applicable premium
surcharges are due to the health care authority (HCA) or the contracted vendor
no later than 45 days after the election period ends as described within the
Washington Administrative Code applicable to the subscriber. Premiums and
applicable premium surcharges associated with continuing PEBB medical must be
made to the HCA as well as premiums associated with continuing PEBB dental,
PEBB vision, or long-term disability (LTD) insurance coverage. Any medicare
part D late enrollment penalty associated with the medicare
advantage-prescription drug plan or Uniform Medical Plan Classic medicare plan
must be made to the contracted vendor. Premiums associated with life insurance
and accidental death and dismemberment (AD&D) insurance coverage must be
made to the contracted vendor. Following the first premium payment, premiums
and applicable premium surcharges must be paid as premiums become due.
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Exceptions:
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(1) A subscriber electing to enroll in PEBB retiree
insurance coverage who elects to pay premiums by deducting from their
Washington state department of retirement systems pension retirement benefit is
not required to make the first premium payment and applicable premium
surcharges to begin enrollment. If there is a delay in the deduction from the
pension when the subscriber first enrolls, HCA will send an invoice to the
subscriber for the first premium payment and applicable premium
surcharges.
(2) A subscriber enrolled in continuation coverage
as defined in WAC
182-08-015 or
182-30-020 who is electing to
enroll in PEBB retiree insurance coverage, or a subscriber enrolled in
continuation coverage as defined in WAC
182-08-015 who is electing to
enroll in another type of continuation coverage is not required to make the
first premium payment and applicable premium surcharges to begin the new
enrollment.
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(b)
For employees who are eligible for the employer contribution, premiums and
applicable premium surcharges are due to the employing agency or contracted
vendor. If an employee elects supplemental coverage or employee-paid LTD
insurance, or is enrolled in employee-paid LTD insurance as described in WAC
182-08-197 (1)(a) or
(3)(a), or is enrolled in employee-paid LTD
insurance as described in WAC
182-08-197
(1)(b), the employee is responsible for
payment of premiums from the month that the supplemental coverage or
employee-paid LTD insurance begins.
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Exception:
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An employee who is on a leave of absence and
maintains eligibility for the employer contribution, will have their premiums
waived for their employee-paid LTD insurance for the first 90 days. For this
purpose, "leave of absence" is defined as a paid or unpaid temporary or
indefinite administrative leave, involuntary leave, sick leave, or insurance
continued under the federal Family and Medical Leave Act, or paid family and
medical leave program as described in WAC
182-12-138.
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(c)
Unpaid or underpaid premiums or applicable premium surcharges for all
subscribers must be paid, and are due from the employing agency, subscriber, or
a subscriber's legal representative to the HCA or contacted vendor. For
subscribers not eligible for the employer contribution, monthly premiums or
applicable premium surcharges that remain unpaid for 30 days will be considered
delinquent. A subscriber is allowed a grace period of 30 days from the date the
monthly premiums or applicable premium surcharges become delinquent to pay the
unpaid premium balance or applicable premium surcharges. If a subscriber's
monthly premiums or applicable premium surcharges remain unpaid for 60 days
from the original due date, the subscriber's PEBB insurance coverage will be
terminated retroactive to the last day of the month for which the monthly
premiums and any applicable premium surcharges were paid. If it is determined
by the HCA that payment of the unpaid balance in a lump sum would be considered
a hardship, the HCA may develop a reasonable payment plan of up to 12 months in
duration with the subscriber or the subscriber's legal representative upon
request.
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Exception:
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For a subscriber enrolled in a medicare advantage
plan, a medicare advantage-prescription drug plan, or the Uniform Medical Plan
Classic medicare plan a notice will be sent to them notifying them that they
are delinquent on their monthly premiums and that the enrollment will be
terminated prospectively to the end of the month after the notice is
sent.
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(d)
Monthly premiums or applicable premium surcharges due from a subscriber who is
not eligible for the employer contribution will be considered unpaid if one of
the following occurs:
(i) No payment of
premiums or applicable premium surcharges are received by the HCA or contracted
vendor and the monthly premiums or applicable premium surcharges remain unpaid
for 30 days; or
(ii) Premium
payments or applicable premium surcharges received by the HCA or contracted
vendor are underpaid by an amount greater than an insignificant shortfall and
the monthly premiums or applicable premium surcharges remain underpaid for 30
days past the date the monthly premiums or applicable premium surcharges were
due.
(e) When an enrolled
retiree dies on or after June 6, 2024, the premium payments for PEBB medical,
PEBB dental, PEBB vision, and any applicable premium surcharges for the retiree
will be waived by HCA for the month in which the death occurred. Subscribers
enrolled as described in WAC
182-12-265
(2)(c) will be responsible for their
continued payment of premiums and applicable premium surcharges as described in
this section.
(2)
Premium refunds. PEBB insurance coverage premiums and applicable
premium surcharges will be refunded using the following methods:
(a) When a subscriber submits an enrollment
change affecting subscriber or dependent eligibility, HCA may allow up to three
months of accounting adjustments. HCA will refund to the individual or the
employing agency any excess premiums and applicable premium surcharges paid
during the 60-day adjustment period, except as indicated in WAC
182-12-148(5).
(b) When premiums and applicable premium
surcharges are waived for a retiree who dies as described in subsection (1)(e)
of this section, HCA will refund any excess premiums and applicable premium
surcharges paid to the retiree's estate, to the department of retirement
systems, or apply any excess premiums to the surviving dependent's
account.
(c) If a PEBB subscriber,
dependent, or beneficiary submits a written appeal as described in WAC
182-16-2010, and provides clear
and convincing evidence of extraordinary circumstances, such that the
subscriber could not timely submit the necessary information to accomplish an
allowable enrollment change within 60 days after the event that created a
change of premiums, the PEBB director, the PEBB director's designee, or the
PEBB appeals unit may:
(i) Approve a refund
of premiums and applicable premium surcharges which does not exceed 12 months
of premiums; and
(ii) Approve the
enrollment change that was originally requested and which forms the basis for
the refund.
(d) If a
federal government entity determines that an enrollee is retroactively enrolled
in coverage (for example, medicare) the subscriber or beneficiary may be
eligible for a refund of premiums and applicable premium surcharges paid during
the time they were enrolled under the federal program if approved by the PEBB
director or the PEBB director's designee.
(e) HCA errors will be corrected by returning
all excess premiums and applicable premium surcharges paid by the employing
agency, subscriber, or beneficiary.
(f) Employing agency errors will be corrected
by returning all excess premiums and applicable premium surcharges paid by the
employee or beneficiary as described in WAC
182-08-187 (4) and
(5).
Statutory
Authority:
RCW
41.05.160 and
2012 2nd sp.s. c
3 . WSR 13-22-019 (Admin. 2013-01),
§182-08-180, filed 10/28/13, effective 1/1/14. Statutory Authority:
RCW
41.05.160. WSR 12-20-022 (Order 2012-01),
§182-08-180, 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), §182-08-180,
filed 10/26/11, effective 1/1/12. Statutory Authority:
RCW
41.05.160. WSR 10-20-147 (Order 10-02),
§182-08-180, filed 10/6/10, effective 1/1/11; WSR 09-23-102 (Order 09-02),
§182-08-180, filed 11/17/09, effective 1/1/10; WSR 08-20-128 (Order
08-03), §182-08-180, filed 10/1/08, effective 1/1/09; WSR 07-20-129 (Order
07-01), §182-08-180, filed 10/3/07, effective 11/3/07. Statutory
Authority:
RCW
41.05.160 and
41.05.165. WSR 04-18-039,
§182-08-180, filed 8/26/04, effective 1/1/05; WSR 03-17-031 (Order 02-07),
§182-08-180, filed 8/14/03, effective 9/14/03. Statutory Authority:
Chapter 41.05 RCW. WSR 96-08-042, §182-08-180, filed 3/29/96, effective
4/29/96; Order 01-77, §182-08-180, filed 8/26/77. WSR 13-21-033,
§182-08-180, filed 10/9/2013, effective
11/9/2013
