Washington Administrative Code
Title 182 - Health Care Authority
PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM
Chapter 182-12 - Eligible and noneligible employees
Section 182-12-114 - How do employees establish eligibility for public employees benefits board (PEBB) benefits?
Universal Citation: WA Admin Code 182-12-114
Current through Register Vol. 24-18, September 15, 2024
Eligibility for an employee whose work circumstances are described by more than one of the eligibility categories in subsections (1) through (5) of this section shall be determined solely by the criteria of the category that most closely describes the employee's work circumstances.
Hours that are excluded in determining eligibility include standby hours and any temporary increases in work hours, of six months or less, caused by training or emergencies (except governor-declared emergencies) that have not been or are not anticipated to be part of the employee's regular work schedule or pattern. Any hours worked in direct response to a governor-declared emergency are not excludable and must be included in determining eligibility. In order to include excluded hours in determining eligibility, employing agencies must request and receive the public employees benefits board (PEBB) program's approval.
For how the employer contribution toward PEBB benefits is maintained after eligibility is established under this section, see WAC 182-12-131.
(1) Employees are eligible for PEBB benefits as follows, except as described in subsections (2) through (5) of this section:
(a)
Eligibility. An employee is
eligible if they are anticipated to work an average of at least 80 hours per
month and are anticipated to work for at least eight hours in each month for
more than six consecutive months.
(b)
Determining eligibility.
(i)
Upon employment: An employee
is eligible from the date of employment if the employing agency anticipates the
employee will work according to the criteria in (a) of this
subsection.
(ii)
Upon
revision of anticipated work pattern: If an employing agency revises an
employee's anticipated work hours or anticipated duration of employment such
that the employee meets the eligibility criteria in (a) of this subsection, the
employee becomes eligible when the revision is made.
(iii)
Based on work pattern: An
employee who is determined to be ineligible, but later meets the eligibility
criteria in (a) of this subsection, becomes eligible the first of the month
following the six-month averaging period.
(c)
Stacking of hours. As long
as the work is within one state agency, employees may "stack" or combine hours
worked in more than one position or job to establish eligibility and maintain
the employer contribution toward PEBB benefits. Employees become eligible
through stacking when they meet the requirements described in (a) of this
subsection. They must notify their employing agency if they believe they are
eligible through stacking. Stacking includes work situations in which:
(i) The employee works two or more positions
or jobs at the same time (concurrent stacking);
(ii) The employee moves from one position or
job to another (consecutive stacking); or
(iii) The employee combines hours from a
seasonal position with hours from a nonseasonal position or job. An employee
who establishes eligibility by stacking hours from a seasonal position or job
with hours from a nonseasonal position or job shall maintain the employer
contribution toward PEBB benefits as described in WAC
182-12-131(1).
(d)
When PEBB benefits
begin. Medical, dental, vision, basic life insurance, basic accidental
death and dismemberment (AD&D) insurance, employer-paid long-term
disability (LTD) insurance, employee-paid LTD insurance (unless the employee
declines the employee-paid LTD insurance as described in WAC
182-08-197(1)),
and if eligible, benefits under the salary reduction plan begin on the first
day of the month following the date an employee becomes eligible. If the
employee becomes eligible on the first working day of a month, then coverage
begins on that date. Supplemental life insurance and supplemental AD&D
insurance begin on the first day of the month following the date the contracted
vendor receives the required form or approves the enrollment.
(2) Seasonal employees, as defined in WAC 182-12-109, are eligible as follows:
(a)
Eligibility. A
seasonal employee is eligible if they are anticipated to work an average of at
least 80 hours per month and are anticipated to work for at least eight hours
in each month of at least three consecutive months of the season.
(b)
Determining eligibility.
(i)
Upon employment: A seasonal
employee is eligible from the date of employment if the employing agency
anticipates that they will work according to the criteria in (a) of this
subsection.
(ii)
Upon
revision of anticipated work pattern. If an employing agency revises an
employee's anticipated work hours or anticipated duration of employment such
that the employee meets the eligibility criteria in (a) of this subsection, the
employee becomes eligible when the revision is made.
(iii)
Based on work pattern. An
employee who is determined to be ineligible for benefits, but later works an
average of at least 80 hours per month and works for at least eight hours in
each month and works for more than six consecutive months, becomes eligible the
first of the month following a six-month averaging period.
(c)
Stacking of hours. As long
as the work is within one state agency, employees may "stack" or combine hours
worked in more than one position or job to establish eligibility and maintain
the employer contribution toward PEBB benefits. Employees become eligible
through stacking when they meet the requirements described in (a) of this
subsection. They must notify their employing agency if they believe they are
eligible through stacking. Stacking includes work situations in which:
(i) The employee works two or more positions
or jobs at the same time (concurrent stacking);
(ii) The employee moves from one position or
job to another (consecutive stacking); or
(iii) The employee combines hours from a
seasonal position or job with hours from a nonseasonal position or job. An
employee who establishes eligibility by stacking hours from a seasonal position
or job with hours from a nonseasonal position or job shall maintain the
employer contribution toward PEBB benefits as described in WAC
182-12-131(1).
(d)
When PEBB benefits begin.
Medical, dental, vision, basic life insurance, basic AD&D insurance,
employer-paid LTD insurance, employee-paid LTD insurance (unless the employee
declines the employee-paid LTD insurance as described in WAC
182-08-197(1)),
and if eligible, benefits under the salary reduction plan begin on the first
day of the month following the day the employee becomes eligible. If the
employee becomes eligible on the first working day of a month, then coverage
begins on that date. Supplemental life insurance and supplemental AD&D
insurance begin on the first day of the month following the date the contracted
vendor receives the required form or approves the enrollment.
|
Exception: |
Seasonal employees who work a recurring, annual season with a duration of less than nine months are not eligible for the employee-paid LTD insurance benefit. |
(3) Faculty are eligible as follows:
(a)
Determining
eligibility. "Half-time" means one-half of the full-time academic
workload as determined by each institution, except that half-time for community
and technical college faculty employees is governed by
RCW
28B.50.489.
(i)
Upon employment: Faculty who
the employing agency anticipates will work half-time or more for the entire
instructional year, or equivalent nine-month period, are eligible from the date
of employment.
(ii)
For
faculty hired on quarter/semester to quarter/semester basis: Faculty who
the employing agency anticipates will not work for the entire instructional
year, or equivalent nine-month period, are eligible at the beginning of the
second consecutive quarter or semester of employment in which they are
anticipated to work, or has actually worked, half-time or more. Spring and fall
are considered consecutive quarters/semesters when first establishing
eligibility for faculty that work less than half-time during the summer
quarter/semester.
(iii)
Upon
revision of anticipated work pattern: Faculty who receive additional
workload after the beginning of the anticipated work period (quarter, semester,
or instructional year), such that their workload meets the eligibility criteria
as described in (a)(i) or (ii) of this subsection become eligible when the
revision is made.
(b)
Stacking. Faculty may establish eligibility and maintain the
employer contribution toward PEBB benefits by working as faculty for more than
one institution of higher education. Faculty workloads may only be stacked with
other faculty workloads to establish eligibility under this section or maintain
eligibility as described in WAC
182-12-131(3). A
faculty becomes eligible through stacking when they meet the requirements as
described in (a) of this subsection. When a faculty works for more than one
institution of higher education, the faculty must notify their employing
agencies that they work at more than one institution and may be eligible
through stacking.
(c)
When
PEBB benefits begin.
(i) Medical,
dental, vision, basic life insurance, basic AD&D insurance, employer-paid
LTD insurance, employee-paid LTD insurance (unless the faculty declines the
employee-paid LTD insurance as described in WAC
182-08-197(1)),
and if eligible, benefits under the salary reduction plan begin on the first
day of the month following the day the faculty becomes eligible. If the faculty
becomes eligible on the first working day of a month, then coverage begins on
that date. Supplemental life insurance and supplemental AD&D insurance
begin on the first day of the month following the date the contracted vendor
receives the required form or approves the enrollment.
(ii) For faculty hired on a quarter/semester
to quarter/semester basis under (a)(ii) of this subsection, medical, dental,
vision, basic life insurance, basic AD&D insurance, employer-paid LTD
insurance, employee-paid LTD insurance (unless the faculty declines the
employee-paid LTD insurance as described in WAC
182-08-197(1)),
and if eligible, benefits under the salary reduction plan begin the first day
of the month following the beginning of the second consecutive quarter/
semester of half-time or more employment. If the first day of the second
consecutive quarter/semester is the first working day of the month, then
coverage begins at the beginning of the second consecutive quarter/semester.
Supplemental life insurance and supplemental AD&D insurance begin on the
first day of the month following the date the contracted vendor receives the
required form or approves the enrollment.
(4) Elected and full-time appointed officials of the legislative and executive branches of state government are eligible as follows:
(a)
Eligibility. A legislator is eligible for PEBB benefits on the
date their term begins. All other elected and full-time appointed officials of
the legislative and executive branches of state government are eligible on the
date their terms begin or the date they take the oath of office, whichever
occurs first.
(b)
When PEBB
benefits begin. Medical, dental, vision, basic life insurance, basic
AD&D insurance, employer-paid LTD insurance, employee-paid LTD insurance
(unless the employee declines the employee-paid LTD insurance as described in
WAC 182-08-197(1)),
and if eligible, benefits under the salary reduction plan begin on the first
day of the month following the day the employee becomes eligible. If the
employee becomes eligible on the first working day of a month, then coverage
begins on that date. Supplemental life insurance and supplemental AD&D
insurance begin on the first day of the month following the date the contracted
vendor receives the required form or approves the
enrollment.
(5) Justices and judges are eligible as follows:
(a)
Eligibility. A justice of
the supreme court and judges of the court of appeals and the superior courts
become eligible for PEBB benefits on the date they take the oath of
office.
(b)
When PEBB
benefits begin. Medical, dental, vision, basic life insurance, basic
AD&D insurance, employer-paid LTD insurance, employee-paid LTD insurance
(unless the employee declines the employee-paid LTD insurance as described in
WAC 182-08-197(1)),
and if eligible, benefits under the salary reduction plan begin on the first
day of the month following the day the employee becomes eligible. If the
employee becomes eligible on the first working day of a month, then coverage
begins on that date. Supplemental life insurance and supplemental AD&D
insurance begin on the first day of the month following the date the contracted
vendor receives the required form or approves the
enrollment.
Statutory Authority: RCW 41.05.160 and 2012 2nd sp.s. c 3 . WSR 13-22-019 (Admin. 2013-01), §182-12-114, filed 10/28/13, effective 1/1/14. Statutory Authority: RCW 41.05.160. WSR 10-20-147 (Order 10-02), §182-12-114, filed 10/6/10, effective 1/1/11; WSR 09-23-102 (Order 09-02), §182-12-114, filed 11/17/09, effective 1/1/10. WSR 13-21-033, §182-12-114, filed 10/9/2013, effective 11/9/2013
Disclaimer: These regulations may not be the most recent version. Washington may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
