Current through Register Vol. 24-18, September 15, 2024
(1) All state
agencies must carry out all actions, policies, and guidance issued by the
public employees benefits board (PEBB) program necessary for the operation of
benefit plans, education of employees, claims administration, and appeals
process including those described in chapters 182-08, 182-12, and 182-16 WAC.
State agencies must:
(a) Use the methods
provided by the PEBB program to determine eligibility and enrollment in
benefits, unless otherwise approved in writing;
(b) Provide eligibility determination reports
with content and in a format designed and communicated by the PEBB program or
otherwise as approved in writing by the PEBB program; and
(c) Carry out corrective action and pay any
penalties imposed by the authority and established by the board when the state
agency's eligibility determinations fail to comply with the criteria under
these rules.
(2) All
state agencies must determine employee eligibility for PEBB benefits and the
employer contribution according to the criteria in WAC
182-12-114 and
182-12-131. State agencies must:
(a) Notify newly hired employees of PEBB
program rules and guidance for eligibility and appeal rights;
(b) Provide written notice to faculty who are
potentially eligible for benefits and employer contribution of their potential
eligibility as described in WAC
182-12-114(3)
and 182-12-131;
(c) Inform an employee in writing whether or
not they are eligible for PEBB benefits upon employment. The written notice
must include a description of any hours that are excluded in determining
eligibility and information about the employee's right to appeal eligibility
and enrollment decisions. An employee eligible for PEBB benefits must have no
less than 10 calendar days after the date of notice to elect
coverage;
(d) Routinely monitor all
employees' eligible work hours to establish eligibility and maintain the
employer contribution toward PEBB benefits;
(e) Make eligibility determinations based on
the criteria of the eligibility category that most closely describes the
employee's work circumstances per the PEBB program's direction;
(f) Identify when a previously ineligible
employee becomes eligible or a previously eligible employee loses eligibility;
and
(g) Inform an employee in
writing whether or not they are eligible for PEBB benefits and the employer
contribution whenever there is a change in work pattern such that the
employee's eligibility status changes. Whenever this occurs, state agencies
must inform the employee of the right to appeal eligibility and enrollment
decisions. An employee eligible for PEBB benefits must have no less than 10
calendar days after the date of notice to elect coverage.
(3) State agencies must determine employee's
dependents eligibility for PEBB health plan coverage according to the criteria
in WAC 182-12-260.
(4) State agencies must assist an employee in
determining whether or not the employee or their dependent has experienced an
event that creates a special open enrollment as described in WAC
182-08-198,
182-08-199,
182-12-128, or
182-12-262, and inform the
employee of the changes they can make consistent with that event.
Statutory Authority:
RCW
41.05.160. 12-20-022 (Order 2012-01),
§182-12-113, filed 9/25/12, effective 11/1/12; 09-23-102 (Order 09-02),
§182-12-113, filed 11/17/09, effective
1/1/10.
