Current through Register Vol. 24-18, September 15, 2024
Public employees benefits board (PEBB) medical and dental
coverage is limited to a single enrollment per individual as described in
subsections (1) through (5) of this section. Effective January 1, 2022,
individuals are limited to a single enrollment in medical, dental, and vision
plans in either the PEBB program or school employees benefits board (SEBB)
program as described in subsection (6) of this section.
(1) An individual who has more than one
source of eligibility for enrollment in PEBB medical and PEBB dental coverage
(called "dual eligibility") is limited to one enrollment.
(2) An eligible employee may waive PEBB
medical and enroll as a dependent under the PEBB medical plan of their spouse,
state registered domestic partner, or parent as described in WAC
182-12-128.
(3) A dependent enrolled in PEBB medical or
PEBB dental who becomes eligible for PEBB benefits as an employee must elect to
enroll in PEBB benefits as described in WAC
182-08-197(1) or
(3). This includes making an election to
enroll in or waive enrollment in PEBB medical as described in WAC
182-12-128.
(a) If the employee does not waive enrollment
in PEBB medical, the employee is not eligible to remain enrolled in their
spouse's, state registered domestic partner's, or parent's PEBB medical as a
dependent. If the employee's spouse, state registered domestic partner, or
parent does not take action to remove the employee (who is enrolled as a
dependent) from their subscriber account, the PEBB program will automatically
disenroll the employee's enrollment as a dependent the last day of the month
before the employee's enrollment in PEBB benefits begins as described in WAC
182-12-114.
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Exception:
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An enrolled dependent who becomes newly eligible for
PEBB benefits as an employee may be dual-enrolled in PEBB medical and dental
for one month. This exception is only allowed for the first month the dependent
is enrolled as an employee, and only if the dependent becomes enrolled as an
employee on the first working day of a month that is not the first day of the
month.
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(b)
If the employee elects to waive their enrollment in PEBB medical, the employee
will remain enrolled in PEBB medical under their spouse's, state registered
domestic partner's, or parent's PEBB medical as a dependent.
(4) A child who is eligible for
PEBB medical and PEBB dental under two subscribers may be enrolled under both
subscribers but is limited to a single enrollment in PEBB medical and a single
enrollment in PEBB dental.
(5) When
an employee is eligible for the employer contribution toward PEBB benefits due
to employment in more than one PEBB-partici-pating employing agency the
following provisions apply:
(a) The employee
must choose to enroll under only one employing agency.
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Exception:
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Faculty who stack to establish or maintain
eligibility as described in WAC
182-12-114(3)
with two or more state institutions of higher education will be enrolled under
the employing agency responsible to pay the employer contribution according to
WAC 182-08-200(2).
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(b)
If the employee loses eligibility under the employing agency, they must notify
their other employing agency no later than 60 days from the date PEBB benefits
end through the employing agency described in (a) of this subsection to
transfer coverage.
(c) The
employee's elections remain the same when an employee transfers their
enrollment under one employing agency to another employing agency without a
break in PEBB benefits for one month or more, as described in (b) of this
subsection.
(6) An
individual who has more than one source of eligibility for enrollment in the
PEBB and SEBB programs is limited to a single enrollment in medical, dental,
and vision plans in either the PEBB or SEBB program. An employee must elect to
enroll in PEBB benefits as described in WAC
182-08-197, waive enrollment as
described in WAC
182-12-128, or remove eligible
dependents as described in WAC
182-12-262. If the employee takes
no action to resolve the dual enrollment, the PEBB program or the SEBB program
will automatically enroll or automatically disenroll the individual as
described in (d) through (h) of this subsection.
(a) An eligible employee may waive enrollment
in PEBB medical to enroll in SEBB medical only if they are enrolled in SEBB
dental and SEBB vision as described in WAC
182-12-128. An employee who
waives enrollment in PEBB medical to enroll in SEBB medical also waives
enrollment in PEBB dental.
(b) An
eligible employee who waives enrollment in PEBB medical when they are enrolled
in other employer-based group medical, a TRI-CARE plan, or medicare as
described in WAC
182-12-128, and are not enrolled
in SEBB medical, may waive enrollment in PEBB dental only if they are enrolled
in both SEBB dental and SEBB vision as an eligible dependent in the SEBB
program.
(c) A school employee in
the SEBB program who waives SEBB medical, SEBB dental, and SEBB vision for PEBB
medical must be enrolled in PEBB dental. If the school employee is not already
enrolled in PEBB dental, the PEBB program will automatically enroll the school
employee in the associated subscriber's PEBB dental.
(d) If the employee is enrolled only in PEBB
dental, and is also enrolled in SEBB medical, and no action is taken to resolve
their dual enrollment, the employee will remain in SEBB medical. The PEBB
program will automatically disenroll the employee from PEBB dental in which
they are enrolled. If the employee is not already enrolled in SEBB dental or
SEBB vision, the SEBB program will automatically enroll them in both as
described in WAC
182-31-070(6)(g).
The employee's enrollment in PEBB program life insurance, accidental death and
dismemberment (AD&D) insurance, and long-term disability (LTD) insurance
will remain.
(e) If the employee is
enrolled in PEBB medical and is also a school employee in the SEBB program and
enrolled in SEBB medical, and the employee has been enrolled in SEBB medical
longer than they have been enrolled in PEBB medical, and no action is taken by
the employee to resolve their dual enrollment, they will remain in SEBB
medical. The PEBB program will automatically disenroll the employee from PEBB
medical and PEBB dental. The employee's enrollment in PEBB program life
insurance, AD&D insurance, and LTD insurance will remain. If the employee
is not enrolled in medical under either the PEBB or SEBB program but is
enrolled only in PEBB dental and SEBB vision (with or without enrollment in
SEBB dental), the employee will remain in SEBB vision and if enrolled, SEBB
dental. If the employee is not already enrolled in SEBB dental, the SEBB
program will automatically enroll them as described in WAC
182-31-070(6)(g).
The PEBB program will automatically disenroll the employee from PEBB
dental.
(f) If the employee's
dependent is enrolled in any PEBB medical or PEBB dental plan, and the
dependent is also a school employee in the SEBB program and enrolled in SEBB
medical, and no action is taken by either the employee or the dependent to
resolve the dependent's dual enrollment, the employee's dependent will remain
in SEBB medical. The PEBB program will automatically disenroll the employee's
dependent from PEBB medical and PEBB dental in which they are
enrolled.
(g) If the employee's
dependent is enrolled in both PEBB medical and SEBB medical as a dependent and
has been enrolled in SEBB medical longer than they have been enrolled in PEBB
medical, and no action is taken to resolve the dual enrollment, the employee's
dependent will remain in SEBB medical. The PEBB program will automatically
disenroll the employee's dependent from PEBB medical and PEBB dental if they
are enrolled. If the employee's dependent who is eligible as a dependent in
both the PEBB and SEBB programs is not enrolled in any medical but is enrolled
only in PEBB dental and SEBB vision (with or without SEBB dental) as a
dependent, the dependent will remain in SEBB vision and if enrolled, SEBB
dental. The PEBB program will automatically disen-roll the employee's dependent
from PEBB dental.
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Exception:
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If there is a National Medical Support Notice (NMSN)
or a court order in place, enrollment will be in accordance with the NMSN or
order.
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(h)
If the employee's dependent, who is also a school employee in the SEBB program
who the SEBB program automatically disenrolled from SEBB dental and SEBB
vision, the PEBB program will automatically enroll the employee's dependent in
PEBB dental, if they are not already enrolled.
(i) If the employee who is eligible for the
employer contribution toward PEBB benefits was enrolled as a dependent in SEBB
medical, SEBB dental, and SEBB vision and is removed by the SEBB subscriber,
the employee will be required to return from waived enrollment as described in
WAC 182-12-128(3)(b).
(j) If the PEBB program automatically
disenrolls an individual from PEBB medical or PEBB dental to resolve their dual
enrollment as described in (e), (f), or (g) of this subsection, but later
determines that the employee did take action to resolve their dual enrollment
within the required timelines, the PEBB program will reinstate coverage
retroactive to the first of the month in which the individual was
disenrolled.
(7) A
retiree who defers enrollment in PEBB retiree insurance coverage as described
in WAC 182-12-200 by enrolling as an
eligible dependent in a health plan sponsored by PEBB or SEBB and who loses the
employer contribution for such coverage must enroll in PEBB retiree insurance
coverage as described in WAC
182-12-200 or defer enrollment as
described in WAC
182-12-205.
Statutory
Authority:
RCW
41.05.160 and
2012 2nd sp.s. c
3 . WSR 13-22-019 (Admin. 2013-01),
§182-12-123, filed 10/28/13, effective 1/1/14. Statutory Authority:
RCW
41.05.160. WSR 12-20-022 (Order 2012-01),
§182-12-123, filed 9/25/12, effective 11/1/12; WSR 10-20-147 (Order
10-02), §182-12-123, filed 10/6/10, effective 1/1/11; WSR 09-23-102 (Order
09-02), §182-12-123, filed 11/17/09, effective 1/1/10; WSR 07-20-129
(Order 07-01), §182-12-123, filed 10/3/07, effective 11/3/07. Statutory
Authority:
RCW
41.05.160 and
41.05.165. WSR 04-18-039,
§182-12-123, filed 8/26/04, effective 1/1/05. WSR 13-21-033,
§182-12-123, filed 10/9/2013, effective
11/9/2013
