Current through Register Vol. 24-18, September 15, 2024
An employee who is newly eligible or who regains eligibility
for the employer contribution toward public employees benefits board (PEBB)
benefits enrolls as described in this section.
(1) When an employee is newly eligible for
PEBB benefits:
(a) An employee must complete
the required forms indicating their enrollment elections, including an election
to waive enrollment provided the employee is eligible to waive as described in
WAC 182-12-128. The required forms
must be returned to the employee's employing agency or contracted vendor. Their
employing agency or contracted vendor must receive the forms no later than 31
days after the employee becomes eligible for PEBB benefits under WAC
182-12-114.
(i) An employee may enroll in supplemental
life insurance up to the guaranteed issue coverage amount without evidence of
insurability if the required forms are returned to the employee's employing
agency or contracted vendor as required. An employee may apply for enrollment
in supplemental life insurance over the guaranteed issue coverage amount at any
time during the calendar year by submitting the required form to the contracted
vendor for approval. For an employee who requests a change in their
supplemental life insurance after the election period described in this
subsection, the change begins the first day of the month following the date the
contracted vendor approves the request. An employee may enroll in supplemental
accidental death and dismemberment (AD&D) insurance at any time during the
calendar year without evidence of insurability by submitting the required form
to the contracted vendor.
(ii)
Employees are enrolled in employee-paid long-term disability (LTD) insurance
automatically. An employee may elect to reduce their employee-paid LTD
insurance or decline their employee-paid LTD insurance by returning the form to
their employing agency. An employee may apply for a change in their
employee-paid LTD insurance at any time during the calendar year by submitting
the required form to their employing agency or the contracted vendor. For an
employee who requests a change in their employee-paid LTD insurance after the
election period described in this subsection, the change begins the first day
of the month following the date the employing agency receives the required form
requesting to reduce or decline the employee-paid LTD insurance, or the day of
the month the contracted vendor approves the required form to increase the
employee-paid LTD insurance.
(iii)
If an employee is eligible to participate in the salary reduction plan (see WAC
182-12-116), the employee will
automatically enroll in the premium payment plan upon enrollment in PEBB
medical allowing medical premiums to be taken on a pretax basis. To opt out of
the premium payment plan, a new employee must complete the required form and
return it to their state agency. The form must be received by their state
agency no later than 31 days after the employee becomes eligible for PEBB
benefits.
(iv) If an employee is
eligible to participate in the salary reduction plan (see WAC
182-12-116), the employee may
enroll in the state's medical flexible spending arrangement (FSA) , limited
purpose FSA, dependent care assistance program (DCAP), or both an FSA and DCAP,
except as limited by subsection (4) of this section. To enroll in these PEBB
benefits, the employee must return the required form to their state agency. The
form must be received by the state agency no later than 31 days after the
employee becomes eligible for PEBB benefits.
(b) If a newly eligible employee's employing
agency, or the authority's contracted vendor in the case of life insurance and
AD&D insurance, does not receive the employee's required forms indicating
medical, dental, life insurance, AD&D insurance, and LTD insurance
elections, and the employee's tobacco use status attestation within 31 days of
the employee becoming eligible, their enrollment will be as follows for those
elections not received within 31 days:
(i) A
medical plan determined by the health care authority (HCA);
(ii) A dental plan determined by the
HCA;
(iii) Basic life
insurance;
(iv) Basic AD&D
insurance;
(v) Employer-paid LTD
insurance and employee-paid LTD insurance;
(vi) Dependents will not be enrolled;
and
(vii) A tobacco use premium
surcharge will be incurred as described in WAC
182-08-185(1)(b).
(2) The employer
contribution toward PEBB benefits ends according to WAC
182-12-131. When an employee's
employment ends, participation in the salary reduction plan ends.
(3) When an employee regains eligibility for
the employer contribution toward PEBB benefits, including following a period of
leave described in WAC
182-12-133(1),
or after being between periods of leave as described in WAC
182-12-142(1) and
(2), or
182-12-131(3)(e),
PEBB medical and dental begin on the first day of the month the employee is in
pay status eight or more hours, or the first day of the month in which the
quarter or semester begins for faculty who regains eligibility as described in
WAC 182-12-131(3)(e).
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Note:
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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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(a) An employee
must complete the required forms indicating their enrollment elections,
including an election to waive enrollment if the employee chooses to waive
enrollment as described in WAC
182-12-128. The required forms
must be returned to the employee's employing agency except as described in (d)
of this subsection. Forms must be received by the employing agency, life
insurance contracted vendor, or AD&D contracted vendor, if required, no
later than 31 days after the employee regains eligibility, except as described
in (a)(i) and (b) of this subsection:
(i) An
employee who self-paid for supplemental life insurance or supplemental AD&D
coverage after losing eligibility will maintain that level of coverage upon
return;
(ii) An employee who was
eligible to continue supplemental life insurance but discontinued that
supplemental coverage must submit evidence of insurability to the contracted
vendor if they choose to reen-roll when they regain eligibility for the
employer contribution;
(iii) An
employee who was eligible to continue employee-paid LTD insurance but
discontinued that coverage must submit evidence of insurability for
employee-paid LTD insurance to the contracted vendor when they regain
eligibility for the employer contribution.
(b) An employee or faculty in any of the
following circumstances does not have to return a form indicating employee-paid
LTD insurance elections. Their employee-paid LTD insurance will be
automatically reinstated effective the first day of the month they are in pay
status eight or more hours or the first day of the month in which the quarter
or semester begins for faculty who regains eligibility as described in WAC
182-12-131(3)(e):
(i) The employee continued to self-pay for
their employee-paid LTD insurance after losing eligibility for the employer
contribution;
(ii) The employee was
not eligible to continue employee-paid LTD insurance after losing eligibility
for the employer contribution.
(c) If an employee's employing agency, or
contracted vendor accepting forms directly, does not receive the required forms
within 31 days of the employee regaining eligibility, the employee's enrollment
for those elections not received will be as described in subsection (1)(b)(i)
through (vii) of this section, except as described in (a)(i) and (b) of this
subsection.
(d) If an employee is
eligible to participate in the salary reduction plan (see WAC
182-12-116) the employee may
enroll in the medical FSA, limited purpose FSA, DCAP, or both an FSA and DCAP,
except as limited by subsection (4) of this section. To enroll in these PEBB
benefits, the employee must return the required form to the contracted vendor
or their state agency. The contracted vendor or employee's state agency must
receive the form no later than 31 days after the employee becomes eligible for
PEBB benefits.
(4) If an
employee who is eligible to participate in the salary reduction plan (see WAC
182-12-116) is hired into a new
position that is eligible for PEBB benefits in the same year, the employee may
not resume participation in a DCAP, a medical FSA, or a limited purpose FSA
until the beginning of the next plan year, unless the time between employments
is 30 days or less and within the current plan year. The employee must notify
their new state agency of the transfer by providing the new state agency's
personnel, payroll, or benefits office the required form no later than 31 days
after the employee's first day of work with the new state agency.
(5) An employee's PEBB benefits elections
remain the same when an employee transfers from one employing agency to another
employing agency without a break in PEBB benefits for one month or more. This
includes movement of an employee between any entities described in WAC
182-12-111 and participating in
PEBB benefits. PEBB benefits elections also remain the same when an employee
has a break in employment that does not interrupt their employer contribution
toward PEBB benefits.
(6) When a
retiree becomes eligible for the employer contribution toward PEBB benefits,
PEBB retiree insurance coverage will be automatically deferred. The subscriber
will be exempt from the deferral form requirement.
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Note:
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When the subscriber is no longer eligible for the
employer contribution toward PEBB benefits, they may enroll in PEBB retiree
insurance coverage as described in WAC
182-12-171, or continue in a
deferred status if they meet the requirements in WAC
182-12-200 or
182-12-205.
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Statutory
Authority:
RCW
41.05.160 and
2012 2nd sp.s. c
3 . WSR 13-22-019 (Admin. 2013-01),
§182-08-197, filed 10/28/13, effective 1/1/14. Statutory Authority:
RCW
41.05.160. WSR 12-20-022 (Order 2012-01),
§182-08-197, 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), §182-08-197,
filed 10/26/11, effective 1/1/12. Statutory Authority:
RCW
41.05.160. WSR 10-20-147 (Order 10-02),
§182-08-197, filed 10/6/10, effective 1/1/11; WSR 09-23-102 (Order 09-02),
§182-08-197, filed 11/17/09, effective 1/1/10; WSR 08-20-128 (Order
08-03), §182-08-197, filed 10/1/08, effective 1/1/09; WSR 07-20-129 (Order
07-01), §182-08-197, filed 10/3/07, effective 11/3/07; WSR 06-11-156
(Order 06-02), §182-08-197, filed 5/24/06, effective 6/24/06. Statutory
Authority:
RCW
41.05.160,
41.05.350, and
41.05.165. WSR 05-16-046 (Order
05-01), §182-08-197, filed 7/27/05, effective 8/27/05. WSR 13-21-033,
§182-08-197, filed 10/9/2013, effective
11/9/2013
