Current through Register Vol. 24-18, September 15, 2024
Public employees benefits board (PEBB) medical, dental, and
vision 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, PEBB dental, and PEBB
vision 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,
PEBB dental, or PEBB vision 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, dental, and
vision 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, PEBB dental, and PEBB vision under two subscribers may be
enrolled under both subscribers but is limited to a single enrollment in PEBB
medical, a single enrollment in PEBB dental, and a single enrollment in PEBB
vision.
(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 (c) through (g) 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 and PEBB vision.
(b) 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 and PEBB vision. If the school employee is not already
enrolled in PEBB dental and PEBB vision the PEBB program will automatically
enroll the school employee in the associated subscriber's PEBB dental and PEBB
vision.
(c) If the employee is
enrolled only in PEBB dental and PEBB vision, 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 and PEBB vision 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.
(d) 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, PEBB
dental, and PEBB vision. The employee's enrollment in PEBB program life
insurance, AD&D insurance, and LTD insurance will remain. If the employee
is not enrolled in any medical under either the PEBB or SEBB program but is
enrolled in PEBB dental, PEBB vision, SEBB dental, and SEBB vision, the
employee will remain in SEBB benefits. The PEBB program will automatically
disenroll the employee from PEBB dental and PEBB vision.
(e) If the employee's dependent is enrolled
in any PEBB medical, PEBB dental, or PEBB vision 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, PEBB dental, and PEBB vision in which they are
enrolled.
(f) 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, PEBB dental, and PEBB
vision 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 in both a PEBB and SEBB dental plan, PEBB and SEBB vision plan, or
any combination of these coverages as a dependent, the dependent will remain in
SEBB benefits. The PEBB program will automatically disenroll the employee's
dependent from PEBB benefits.
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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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(g)
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 and PEBB vision, if they are not already enrolled.
(h) 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).
(i) If the PEBB program automatically
disenrolls an individual from PEBB medical, PEBB dental, or PEBB vision to
resolve their dual enrollment as described in (d), (e), or (f) 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
