Current through Register Vol. 24-18, September 15, 2024
A retiring employee or a retiring school employee is eligible
to continue enrollment or defer enrollment in public employees benefits board
(PEBB) insurance coverage as a retiree if they meet procedural and substantive
eligibility requirements as described in subsections (1), (2), and (3) of this
section. An elected and full-time appointed official of the legislative and
executive branch of state government is eligible as described in WAC
182-12-180.
(1)
Procedural requirements. A
retiring employee or a retiring school employee must enroll or defer enrollment
in PEBB retiree insurance coverage as described in (a) through (e) of this
subsection:
(a) To enroll in PEBB retiree
insurance coverage, the required form must be received by the PEBB program no
later than 60 days after the employee's or the school employee's own
employer-paid coverage, Consolidated Omnibus Budget Reconciliation Act (COBRA)
coverage, or continuation coverage ends. The effective date of PEBB retiree
insurance coverage is the first day of the month after the employee's or the
school employee's employer-paid coverage, COBRA coverage, or continuation
coverage ends;
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Note:
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Enrollment in the PEBB program's medicare advantage
(MA) plan, medicare advantage-prescription drug (MA-PD) plan, or the Uniform
Medical Plan (UMP) Classic medicare plan may not be retroactive.
(1) If a subscriber elects to enroll in a MA plan,
and the required forms are received by the PEBB program after the date the PEBB
retiree insurance coverage is to begin, the subscriber and their enrolled
dependents will be enrolled in a plan with the same contracted vendor during
the gap month(s) prior to when MA coverage begins.
(2) If a subscriber elects to enroll in a MA-PD
plan, and the required forms are received by the PEBB program after the date
the PEBB retiree insurance coverage is to begin, the subscriber and their
enrolled dependents will be enrolled in transitional coverage as designated by
the director or designee during the gap month(s) prior to when the MA-PD
coverage begins.
(3) If a subscriber elects to enroll in the UMP
Classic medicare plan, and the required forms are received by the PEBB program
after the date the PEBB retiree insurance coverage is to begin, the subscriber
and their enrolled dependents will be enrolled in transitional UMP coverage
during the gap month(s) prior to when the UMP Classic medicare plan
begins.
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(b)
The employee's or the school employee's first premium payment for PEBB retiree
insurance coverage and applicable premium surcharges are due to the health care
authority (HCA) no later than 45 days after the election period ends as
described in (a) of this subsection, except as described in WAC
182-08-180(1)(a).
Following the employee's or the school employee's first premium payment,
premiums and applicable premium surcharges must be paid as described in WAC
182-08-180
(1)(c); and
(c) If a retiring employee or a retiring
school employee elects to enroll a dependent in PEBB health plan coverage, the
dependent must be enrolled in the same PEBB medical and PEBB dental plan as the
retiring employee or the retiring school employee;
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Exceptions:
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(1) If a retiring employee or a retiring school
employee selects a medicare supplement plan, a MA-PD plan, or the UMP Classic
medicare plan, nonmedicare enrollees will be enrolled in the UMP Classic. If a
retiring employee or a retiring school employee selects any other medicare
plan, they must also select a nonmedicare plan with the same contracted vendor
available to nonmedicare enrollees.
(2) If a retiring employee or a retiring school
employee selects a medicare supplement plan, MA-PD plan, or any other medicare
plan, they may elect a PEBB vision plan available for any nonmedicare
enrollees.
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(d) A
nonmedicare retiring employee or retiring school employee must enroll in PEBB
medical to be able to enroll in PEBB dental, in PEBB vision, or in both PEBB
dental and PEBB vision. Any nonmedicare dependents they elect to enroll must be
enrolled in the same PEBB medical, PEBB dental, and PEBB vision plan.
(e) To defer enrollment in PEBB retiree
insurance coverage, the employee or the school employee must meet substantive
eligibility requirements in subsection (2) of this section and defer enrollment
as described in WAC
182-12-200 or
182-12-205.
(2)
Substantive eligibility
requirements.
An employee who is eligible for PEBB benefits through an
employing agency, or a school employee who is eligible for SEBB benefits
through a SEBB organization, a SEBB participating employer group, or basic
benefits through an educational service district as defined in
RCW
28A.400.270 who ends public employment may
enroll or defer enrollment in PEBB retiree insurance coverage if they meet
procedural and substantive eligibility requirements.
To be eligible to continue enrollment or defer enrollment in
PEBB retiree insurance coverage, the employee or the school employee must be
vested in and eligible to retire under a Washington state-sponsored retirement
plan when the employee's or school employee's own employer-paid coverage, COBRA
coverage, or continuation coverage ends. An exception to the requirement to be
vested in and eligible to retire under a Washington state-sponsored retirement
plan is provided for employees of a PEBB participating employer group in (c)(i)
of this subsection and for school employees of a SEBB participating employer
group in (e)(i) of this subsection. To satisfy the requirement to immediately
begin to receive a monthly retirement plan payment as described in (a), (b),
(c)(ii), (d), and (e)(ii) of this subsection, the employee or school employee
must begin receiving a monthly retirement plan payment no later than the first
month following the employee's or school employee's own employer-paid coverage,
COBRA coverage, or continuation coverage ending.
(a) A retiring employee of a state agency
must immediately begin to receive a monthly retirement plan payment, with
exceptions described below:
(i) A retiring
employee who receives a lump sum payment instead of a monthly retirement plan
payment is only eligible if the department of retirement systems offered the
employee the choice between a lump sum actuarially equivalent payment and the
ongoing monthly payment, as allowed by the plan; or
(ii) A retiring employee who is a member of
the teachers' retirement system Plan 2, school employees' retirement system
Plan 2, or public employees' retirement system Plan 2, also called a separated
employee as defined in
RCW
41.05.011 (25)(b), who
separates from employment on or after January 1, 2024, and who is at least age
55 with at least 20 years of service; or
(iii) A retiring employee who is a member of
a Plan 3 retirement plan, also called a separated employee as defined in
RCW
41.05.011 (25)(a), who is at
least age 55 with at least 10 years of service.
(b) A retiring employee of a Washington
higher education institution who is a member of a higher education retirement
plan (HERP) must immediately begin to receive a monthly retirement plan
payment, or meet their HERP plan's retirement eligibility criteria, or be at
least age 55 with 10 years of state service;
(c) A retiring employee of an employer group
participating in PEBB insurance coverage under contractual agreement with the
authority must be eligible to retire as described in (c)(i) or (ii) of this
subsection to be eligible to continue PEBB retiree insurance coverage.
(i) A retiring employee who is eligible to
retire under a retirement plan sponsored by an employer group or tribal
government that is not a Washington state-sponsored retirement plan must meet
the same age and years of service requirements as if they were a member of
public employees retirement system Plan 1, if their date of hire with that
employer group or tribal government was before October 1, 1977, or Plan 2, if
their date of hire with that employer group or tribal government was on or
after October 1, 1977.
(ii) A
retiring employee who is eligible to retire under a Washington state-sponsored
retirement plan must immediately begin to receive a monthly retirement plan
payment, with exceptions described in (a)(i), (ii), or (iii) of this
subsection.
(iii) A retired
employee of an employer group that ends participation in PEBB insurance
coverage is no longer eligible to continue enrollment in PEBB retiree insurance
coverage if they enrolled after September 15, 1991. Any retiree who loses
eligibility for this reason may continue health plan enrollment as described in
WAC 182-12-232.
(iv) A retired
employee of a tribal government employer that ends participation in PEBB
insurance coverage is no longer eligible to continue enrollment in PEBB retiree
insurance coverage. Any retiree who loses eligibility for this reason may
continue health plan enrollment as described in WAC 182-12-232.
(d) A retiring school employee of
a SEBB organization must immediately begin to receive a monthly retirement plan
payment, with exceptions described below:
(i)
A retiring school employee who ends employment before October 1, 1993;
or
(ii) A retiring school employee
who receives a lump sum payment instead of a monthly retirement plan payment is
only eligible if the department of retirement systems offered the school
employee the choice between a lump sum actuarially equivalent payment and the
ongoing monthly payment, as allowed by the plan, or the school employee
enrolled before 1995; or
(iii) A
retiring school employee who is a member of the teachers' retirement system
Plan 2, school employees' retirement system Plan 2, or public employees'
retirement system Plan 2, also called a separated employee as defined in
RCW
41.05.011 (25)(b), who
separates from employment on or after January 1, 2024, and who is at least age
55 with at least 20 years of service; or
(iv) A retiring school employee who is a
member of a Plan 3 retirement system, also called a separated employee as
defined in
RCW
41.05.011 (25)(a), who is at
least age 55 with at least 10 years of service; or
(v) A school employee who retired as of
September 30, 1993, and began receiving a monthly retirement plan payment from
a Washington state-sponsored retirement system (as defined in chapters 41.32,
41.35 or 41.40 RCW) is eligible if they enrolled in a PEBB health plan no later
than the HCA's annual open enrollment period for the year beginning January 1,
1995.
(e) A retiring
school employee of an employer group participating in SEBB insurance coverage
under contractual agreement with the authority must be eligible to retire as
described in (e)(i) or (ii) of this subsection to be eligible to continue PEBB
retiree insurance coverage.
(i) A retiring
school employee who is eligible to retire under a retirement plan sponsored by
an employer group that is not a Washington state-sponsored retirement plan must
meet the same age and years of service requirements as if they were a member of
teachers retirement system Plan 1, if their date of hire with that employer
group was before October 1, 1977, or Plan 2, if their date of hire with that
employer group was on or after October 1, 1977.
(ii) A retiring school employee who is
eligible to retire under a Washington state-sponsored retirement plan must
immediately begin to receive a monthly retirement plan payment, with exceptions
described in (d)(ii), (iii), or (iv) of this subsection.
(iii) A retired school employee of an
employer group that ends participation in SEBB insurance coverage is no longer
eligible to continue enrollment in PEBB retiree insurance coverage. Any retiree
who loses eligibility for this reason may continue health plan enrollment as
described in WAC 182-12-232.
(3) A retiring employee or a retiring school
employee and their enrolled dependents who are eligible for medicare must
enroll and maintain enrollment in both medicare Parts A and B if the employee
or the school employee retired after July 1, 1991. If a retiree or an enrolled
dependent becomes eligible for medicare after enrollment in PEBB retiree
insurance coverage, they must enroll and maintain enrollment in medicare Parts
A and B to remain enrolled in a PEBB retiree health plan. If an enrollee who is
eligible for medicare does not meet this procedural requirement, the enrollee
is no longer eligible for enrollment in a PEBB retiree health plan. The
enrollee's eligibility will end as described in the termination notice sent by
the PEBB program. The enrollee may continue PEBB health plan enrollment as
described in WAC
182-12-146.
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Note:
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For the exclusive purpose of medicare Part A as
described in this subsection, "eligible" means the enrollee is eligible for
medicare Part A without a monthly premium.
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(4)
Washington state-sponsored retirement plans include:
(a) Higher education retirement
plans;
(b) Law enforcement
officers' and firefighters' retirement system;
(c) Public employees' retirement
system;
(d) Public safety
employees' retirement system;
(e)
School employees' retirement system;
(f) State judges/judicial retirement
system;
(g) Teachers' retirement
system; and
(h) State patrol
retirement system.
(i) The two
federal retirement systems, Civil Service Retirement System and Federal
Employees' Retirement System, are considered Washington state-sponsored
retirement systems for Washington State University Extension for an employee
covered under PEBB benefits at the time of retirement.
Statutory
Authority:
RCW
41.05.160 and
2012 2nd sp.s. c
3 . WSR 13-22-019 (Admin. 2013-01),
§182-12-171, filed 10/28/13, effective 1/1/14. Statutory Authority:
RCW
41.05.160. WSR 12-20-022 (Order 2012-01),
§182-12-171, 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), §182-12-171,
filed 10/26/11, effective 1/1/12. Statutory Authority:
RCW
41.05.160. WSR 10-20-147 (Order 10-02),
§182-12-171, filed 10/6/10, effective 1/1/11; WSR 09-23-102 (Order 09-02),
§182-12-171, filed 11/17/09, effective 1/1/10; WSR 08-20-128 (Order
08-03), §182-12-171, filed 10/1/08, effective 1/1/09; WSR 07-20-129 (Order
07-01), §182-12-171, filed 10/3/07, effective 11/3/07; WSR 06-11-156
(Order 06-02), §182-12-171, 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), §182-12-171, filed 7/27/05, effective 8/27/05. Statutory
Authority:
RCW
41.05.160 and
41.05.165. WSR 04-18-039,
§182-12-171, filed 8/26/04, effective 1/1/05. WSR 13-21-033,
§182-12-171, filed 10/9/2013, effective
11/9/2013
