Current through Register Vol. 24-18, September 15, 2024
(1) An employing
agency or contracted vendor that makes one or more of the following enrollment
errors must correct the error as described in subsections (2) through (5) of
this section.
(a) Failure to timely notify an
employee of their eligibility for public employee benefits board (PEBB)
benefits and the employer contribution as described in WAC
182-12-113(2);
(b) Failure to enroll the employee and their
dependents in PEBB benefits as elected by the employee, if the elections were
timely;
(c) Failure to enroll an
employee and their dependents in PEBB benefits as described in WAC
182-08-197(1)(b);
(d) Failure to accurately reflect an
employee's premium surcharge attestation on the employee's account;
(e) Enrolling an employee or their dependent
in PEBB insurance coverage when they are not eligible as described in WAC
182-12-114 or
182-12-260 and it is clear there
was no fraud or intentional misrepresentation by the employee involved;
or
(f) Providing incorrect
information regarding PEBB benefits to the employee that they relied
upon.
(2) The employing
agency or the applicable contracted vendor must enroll the employee and the
employee's dependents, as elected, or terminate enrollment in PEBB benefits as
described in subsection (3) of this section, reconcile premium payments and
applicable premium surcharges as described in subsection (4) of this section,
and provide recourse as described in subsection (5) of this section.
(3)
Enrollment or termination.
(a) PEBB medical and dental enrollment is
effective the first day of the month following the date the enrollment error is
identified, unless the authority determines additional recourse is warranted,
as described in subsection (5) of this section. If the enrollment error is
identified on the first day of the month, the enrollment correction is
effective that day;
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Exception:
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When an employee who is called to active duty in the
uniformed services under Uniformed Services Employment and Reemployment Rights
Act (USERRA) loses eligibility for the employer contribution toward PEBB
benefits, they regain eligibility for the employer contribution toward PEBB
benefits the day they return from active duty. Employer-paid PEBB benefits will
begin the first day of the month in which they return from active duty.
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(b)
Basic life, basic accidental death and dismemberment (AD&D), employer-paid
long-term disability (LTD) insurance, and employee-paid LTD insurance (unless
the employee declines the employee-paid LTD insurance as described in WAC
182-08-197(1)
enrollment is retroactive to the first day of the month following the day the
employee became newly eligible, or the first day of the month the employee
regained eligibility, as described in WAC
182-08-197. If the employee
became newly eligible on the first working day of a month, basic life, basic
AD&D, employer-paid LTD insurance, and employee-paid LTD insurance begin on
that date;
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Exception:
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When an employee who is called to active duty in the
uniformed services under USERRA loses eligibility for the employer contribution
toward PEBB benefits, they regain eligibility for the employer contribution
toward PEBB benefits the day they return from active duty. Employer-paid PEBB
benefits will begin the first day of the month in which they return from active
duty.
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(c)
Supplemental life, supplemental AD&D, and employee-paid LTD insurance
enrollment is retroactive to the first day of the month following the day the
employee became newly eligible if the employee elects to enroll in this
coverage (or if previously elected, the first of the month following the
signature date on the employee's application for this coverage). If an
employing agency enrollment error occurred when the employee regained
eligibility for the employer contribution following a period of leave as
described in WAC
182-08-197(3):
(i) Supplemental life, supplemental AD&D,
and employee-paid LTD insurance is enrolled the first day of the month the
employee regained eligibility, at the same level of coverage the employee
continued during the period of leave, without evidence of
insurability.
(ii) If the employee
was not eligible to continue employee-paid LTD insurance during the period of
leave as described in WAC
182-12-133, employee-paid LTD
insurance is reinstated the first day of the month the employee regained
eligibility, to the level of coverage the employee was enrolled in prior to the
period of leave, without evidence of insurability.
(iii) If the employee was eligible to
continue supplemental life insurance, supplemental AD&D insurance, and
employee-paid LTD insurance under the period of leave but did not, the employee
must provide evidence of insurability and receive approval from the contracted
vendor.
(d) If the
employee is eligible and elects (or elected) to enroll in the medical flexible
spending arrangement (FSA), limited purpose FSA, or dependent care assistance
program (DCAP), enrollment is limited to 60 days prior to the date enrollment
is processed, but not earlier than the current plan year. If an employee was
not enrolled in a medical FSA, limited purpose FSA, or DCAP as elected, the
employee may either participate at the amount originally elected with a
corresponding increase in contributions for the balance of the plan year, or
participate at a reduced amount for the plan year by maintaining the per-pay
period contribution in effect;
(e)
If the employee or their dependent was not eligible but still enrolled as
described in subsection (1)(e) of this section, the employee's or their
dependent's PEBB benefits will be terminated pro-spectively effective as of the
last day of the month.
(4)
Premium payments.
(a) The employing agency must remit to the
authority the employer contribution and the employee contribution for health
plan premiums, applicable premium surcharges, basic life, basic AD&D, and
employer-paid LTD starting the date PEBB benefits begins as described in
subsections (3) and (5)(a)(i) of this section. If a state agency failed to
notify a newly eligible employee of their eligibility for PEBB benefits, the
state agency may only collect the employee contribution for health plan
premiums and applicable premium surcharges for coverage for the months after
the employee was notified.
(b) When
an employing agency fails to correctly enroll the amount of employee-paid LTD
insurance elected by the employee, premiums will be corrected as follows:
(i) When additional premiums are due to the
authority, the employee is responsible for premiums for the most recent 24
months of coverage. The employing agency is responsible for additional months
of premiums.
(ii) When a premium
refund is due to the employee, the LTD insurance contracted vendor is
responsible for premium refunds for the most recent 24 months of coverage. The
employing agency is responsible for additional months of premium
refund.
(c) When an
employing agency mistakenly enrolls an employee or their dependent as described
in subsection (1)(e) of this section, premiums and any applicable premium
surcharges will be refunded by the employing agency to the employee without
rescinding the insurance coverage.
(5)
Recourse.
(a) Employee eligibility for PEBB benefits
begins on the first day of the month following the date eligibility is
established as described in WAC
182-12-114. Dependent eligibility
is described in WAC
182-12-260, and dependent
enrollment is described in WAC
182-12-262. When retroactive
correction of an enrollment error is limited as described in subsection (3)(b),
(c) and (d) of this section, the employing agency must work with the employee,
and receive approval from the authority, to implement retroactive PEBB benefits
within the following parameters:
(i)
Retroactive enrollment in a PEBB insurance coverage;
(ii) Reimbursement of claims paid;
(iii) Reimbursement of amounts paid by the
employee or dependent for medical and dental premiums;
(iv) Reimbursement of amounts paid by the
employee for the premium surcharges;
(v) Other legal remedy received or offered;
or
(vi) Other recourse, upon
approval by the authority.
(b) Recourse must not contradict a specific
provision of federal law or statute and does not apply to requests for
noncovered services or in the case of an individual who is not eligible for
PEBB benefits.
Statutory
Authority:
RCW
41.05.160 and
2012 2nd sp.s. c
3 . WSR 13-22-019 (Admin. 2013-01),
§182-08-187, filed 10/28/13, effective 1/1/14. WSR 13-21-033,
§182-08-187, filed 10/9/2013, effective
11/9/2013
