Current through Register Vol. 24-18, September 15, 2024
(1) A subscriber must elect a new health plan
when their previously selected health plan becomes unavailable due to a change
in contracting service area as described below:
(a) When a health plan becomes unavailable
during the plan year, a subscriber must elect a new health plan no later than
60 days after the date their previously selected health plan becomes
unavailable.
(i) An employee must submit the
required forms to their employing agency electing their new health
plan.
(ii) Any other subscriber
must submit the required forms to the PEBB program electing their new health
plan.
(iii) The effective date of
the change in health plan will be the first day of the month following the
later of the date the health plan becomes unavailable or the date the form is
received. If that day is the first of the month, the change in health plan
begins on that day.
(b)
When a health plan becomes unavailable at the beginning of the next plan year,
a subscriber must elect a new health plan no later than the last day of the
public employees benefits board (PEBB) annual open enrollment.
(i) An employee must submit the required
forms to their employing agency electing their new health plan.
(ii) Any other subscriber must submit the
required forms to the PEBB program electing their new health plan.
(iii) The effective date of the change in
health plan will be January 1st of the following year.
(c) A subscriber who fails to elect a new
health plan within the required time period as required in (a) or (b) of this
subsection will be enrolled in a health plan designated by the director or
designee.
(2) A
subscriber must elect a new health plan when their previously selected health
plan becomes unavailable due to the subscriber or subscriber's dependent
ceasing to be eligible for their current health plan because of enrollment in
medicare as described below:
(a) The required
forms electing a new health plan must be received no later than 60 days after
the date their previously selected health plan becomes unavailable.
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Exception:
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The required forms electing a new medicare advantage
(MA) plan, medicare advantage-prescription drug (MA-PD) plan, or the Uniform
Medical Plan (UMP) Classic medicare plan must be received no later than two
months after the date their previously selected health plan becomes
unavailable.
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(i) An employee
must submit the required forms to their employing agency electing their new
health plan.
(ii) Any other
subscriber must submit the required forms to the PEBB program electing their
new health plan.
(iii) The
effective date of the change in health plan will be the first day of the month
following the later of the date the health plan becomes unavailable or the date
the form is received. If that day is the first of the month, the change in
health plan begins on that day except for a MA plan, MA-PD plan, or the UMP
Classic medicare plan which will begin the first day of the month following the
date the form is received.
(b) A subscriber who is enrolled in a
consumer directed health plan (CDHP) with a health savings account (HSA), and
fails to elect a new health plan within the required time period as required in
this subsection, will not be eligible to receive contributions to the HSA. A
subscriber will be liable for any tax penalties resulting from contributions
made when they are no longer eligible.
(3) A subscriber must elect a new medical
plan when their previously selected medical plan becomes unavailable due to a
change in their residence as described below.
(a) When a subscriber's medical plan becomes
unavailable during the plan year, a subscriber must elect a new medical plan no
later than 60 days after the date their previously selected medical plan
becomes unavailable as described in WAC
182-08-198
(2)(e).
(i)
An employee must submit the required forms to their employing agency electing
their new medical plan.
(ii) Any
other subscriber must submit the required forms to the PEBB program electing
their new medical plan.
(iii) The
effective date of the change in medical plan will be the first day of the month
following the later of the date the medical plan becomes unavailable or the
date the form is received. If that day is the first of the month, the change in
medical plan begins on that day except for a MA plan, a MA-PD plan, or the UMP
Classic medicare plan which will begin the first day of the month following the
date the form is received.
(b) A subscriber who fails to elect a new
medical plan within the required time period as required in (a) of this
subsection will be enrolled in a public employees benefits board medical plan
designated by the director or designee.
(4) When a subscriber or their dependent must
be disenrolled by a MA plan, MA-PD plan, or a medicare Part D plan as required
by federal law, the subscriber and their enrolled dependents will be enrolled
in a PEBB medical plan as designated by the director or designee. The new
medical plan coverage will begin the first day of the month following the date
the MA plan, the MA-PD plan, or the UMP Classic medicare plan is
terminated.
(5) A subscriber
enrolled in a health plan as described in subsection (1)(c), (2)(b), (3)(b), or
(4) of this section may not change health plans except as allowed in WAC
182-08-198.
Statutory Authority:
RCW
41.05.160 and 2011 c 8. 11-22-036 (Order
11-02), §182-08-196, filed 10/26/11, effective 1/1/12. Statutory
Authority:
RCW
41.05.160. 10-20-147 (Order 10-02),
§182-08-196, filed 10/6/10, effective 1/1/11; 09-23-102 (Order 09-02),
§182-08-196, filed 11/17/09, effective 1/1/10; 08-20-128 (Order 08-03),
§182-08-196, filed 10/1/08, effective 1/1/09; 07-20-129 (Order 07-01),
§182-08-196, filed 10/3/07, effective 11/3/07. Statutory Authority:
RCW
41.05.160,
41.05.350, and
41.05.165. 05-16-046 (Order
05-01), §182-08-196, filed 7/27/05, effective 8/27/05. Statutory
Authority:
RCW
41.05.160 and
41.05.165. 04-18-039,
§182-08-196, filed 8/26/04, effective 1/1/05; 03-17-031 (Order 02-07),
§182-08-196, filed 8/14/03, effective
9/14/03.
