Current through Register Vol. 24-18, September 15, 2024
(1)
Enrolling dependents in public
employees benefits board (PEBB) health plan coverage, supplemental dependent
life insurance, and accidental death and dismemberment (AD&D)
insurance. A dependent must be enrolled in the same health plan coverage
as the subscriber unless otherwise described in the Washington Administrative
Code applicable to the subscriber. The subscriber must be enrolled in health
plan coverage to enroll their dependent in health plan coverage except as
provided in WAC
182-12-205
(3)(c). A dependent with more than one source
of eligibility for enrollment in the PEBB and school employees benefits board
(SEBB) programs is limited to a single enrollment in medical, dental, and
vision plans in either the PEBB or SEBB program. Subscribers must satisfy the
enrollment requirements as described in subsection (4) of this section and may
enroll eligible dependents at the following times:
(a)
When the subscriber becomes
eligible and enrolls in PEBB benefits. If eligibility is verified the
dependent's effective date will be as follows:
(i) PEBB health plan coverage will be the
same as the subscriber's effective date;
(ii) Supplemental dependent life insurance or
AD&D insurance, if elected, will be effective the first day of the month
following the date the contracted vendor receives the required form or approves
the enrollment. A newly born child must be at least 14 days old before
supplemental dependent life insurance or AD&D insurance coverage is
effective.
(b)
During the annual open enrollment. PEBB health plan coverage
begins January 1st of the following year;
(c)
During special open
enrollment. Subscribers may enroll dependents during a special open
enrollment as described in subsection (3) of this section;
(d)
When a National Medical Support
Notice (NMSN) requires a subscriber to cover a dependent child in health
plan coverage as described in WAC
182-12-263; or
(e)
Any time during the calendar year
for supplemental dependent life insurance or AD&D insurance by
submitting the required form to the contracted vendor for approval. Evidence of
insurability may be required for supplemental dependent life insurance but will
not be required for supplemental AD&D insurance. Supplemental dependent
life insurance or AD&D insurance will be effective the first day of the
month following the date the contracted vendor receives the required form or
approves the enrollment. A newly born child must be at least 14 days old before
supplemental dependent life insurance or AD&D insurance coverage is
effective.
(2)
Removing dependents from a subscriber's PEBB health plan coverage or
supplemental dependent life insurance or AD&D insurance.
(a)
A dependent's eligibility for
enrollment in PEBB health plan coverage or supplemental dependent life
insurance or AD&D insurance ends the last day of the month the
dependent meets the eligibility criteria as described in WAC
182-12-250 or
182-12-260. Subscribers must
provide notice when a dependent is no longer eligible due to divorce,
annulment, dissolution, or qualifying event of a dependent ceasing to be
eligible as a dependent child, as described in WAC
182-12-260(3).
For supplemental dependent life insurance or AD&D insurance, subscribers
must notify the contracted vendor on the required form, in writing, or by
telephone when a dependent is no longer eligible. Contact information for the
contracted vendor may be found at hca.wa.gov/employees-contact-plan. For PEBB
health plan coverage, the notice must be received within 60 days of the last
day of the month the dependent loses eligibility. Employees must notify their
employing agency when a dependent is no longer eligible for PEBB health plan
coverage, except as required under WAC
182-12-260
(3)(g)(ii). All other subscribers must notify
the PEBB program. Consequences for not submitting notice within the required 60
days include, but are not limited to:
(i) The
dependent may lose eligibility to continue PEBB medical, dental, or vision
under one of the continuation coverage options described in WAC
182-12-270;
(ii) The subscriber may be billed for claims
paid by the health plan for services that were rendered after the dependent
lost eligibility as described in WAC
182-12-270;
(iii) The subscriber may not be able to
recover subscriber-paid insurance premiums for dependents that lost their
eligibility; and
(iv) The
subscriber may be responsible for premiums paid by the state for the
dependent's health plan coverage after the dependent lost
eligibility.
(b)
Employees have the opportunity to remove eligible dependents:
(i) During the annual open enrollment. The
dependent will be removed from PEBB health plan coverage the last day of
December;
(ii) During a special open
enrollment as described in subsections (3) and (4)(f) of this
section;
(iii) When a NMSN requires
a spouse, former spouse, or other individual to provide health plan coverage
for a dependent who is already enrolled in PEBB coverage, and that health plan
coverage is in fact provided as described in WAC
182-12-263(2);
or
(iv) Any time during the
calendar year from supplemental dependent life insurance or AD&D insurance
by submitting a request to the contracted vendor on the required form, in
writing, or by telephone. Contact information for the contracted vendor may be
found at hca.wa.gov/employees-contact-plan.
(c)
Retirees (see WAC
182-12-171,
182-12-180, or
182-12-211), survivors (see WAC
182-12-180,
182-12-250, or
182-12-265), PEBB continuation
coverage enrollees (see WAC
182-12-133,
182-12-141,
182-12-142,
182-12-146, or
182-12-148), and retired
employees, retired school employees, or survivors continuing PEBB health plan
coverage after their employer group ceased participation (see WAC 182-12-232)
may remove dependents from their PEBB health plan coverage outside of
the annual open enrollment or a special open enrollment by providing written
notice to the PEBB program. The dependent will be removed from the subscriber's
PEBB health plan coverage prospectively. PEBB health plan coverage will end on
the last day of the month in which the written notice is received by the PEBB
program or on the last day of the month specified in the subscriber's written
notice, whichever is later. If the written notice is received on the first day
of the month, PEBB health plan coverage will end on the last day of the
previous month. PEBB continuation coverage enrollees may remove dependents from
supplemental dependent life insurance or AD&D insurance any time during the
calendar year by submitting a request to the contracted vendor on the required
form, in writing, or by telephone. Contact information for the contracted
vendor may be found at hca.wa.gov/employees-contact-plan.
(3)
Special open enrollment.
(a) Subscribers may enroll or remove their
eligible dependents outside of the annual open enrollment if a special open
enrollment event occurs. The change in enrollment must be allowable under the
Internal Revenue Code and Treasury Regulations, and correspond to and be
consistent with the event that creates the special open enrollment for the
subscriber, the subscriber's dependents, or both. To disenroll from a medicare
advantage (MA) plan, a medicare advantage-prescription drug (MA-PD) plan, or
the Uniform Medical Plan (UMP) Classic medicare plan, the change in enrollment
must be allowable under 42
C.F.R. Secs. 422.62(b) and
423.38(c).
(i) PEBB health plan coverage will begin the
first of the month following the later of the event date or the date the
required form is received. If that day is the first of the month, the change in
enrollment begins on that day except for a MA plan, a MA-PD plan, or the UMP
Classic medicare plan, which will begin the first day of the month following
the date the form is received.
(ii)
PEBB health plan coverage for an extended dependent or a dependent with a
disability will begin the first day of the month following the later of the
event date or eligibility certification.
(iii) The dependent will be removed from the
subscriber's PEBB health plan coverage the last day of the month following the
later of the event date or the date the required form and proof of the event is
received. If that day is the first of the month, the change in enrollment will
be made the last day of the previous month.
(iv) If the special open enrollment is due to
the birth or adoption of a child, or when the subscriber has assumed a legal
obligation for total or partial support in anticipation of adoption of a child,
PEBB health plan coverage will begin or end as follows:
* For the newly born child, PEBB health plan coverage will
begin the date of birth;
* For a newly adopted child, PEBB health plan coverage will
begin on the date of placement or the date a legal obligation is assumed in
anticipation of adoption, whichever is earlier;
* For a spouse or state registered domestic partner of a
subscriber, PEBB health plan coverage will begin the first day of the month in
which the event occurs. The spouse or state registered domestic partner will be
removed from PEBB health plan coverage the last day of the month in which the
event occurred.
(v)
Supplemental dependent life insurance or AD&D insurance will begin the
first day of the month following the date the contracted vendor receives the
required form or approves the enrollment. A newly born child must be at least
14 days old before supplemental dependent life insurance or AD&D insurance
coverage is effective.
(b) The events described in this subsection
(3)(b)(i) of this section create a special open enrollment to enroll eligible
dependents in supplemental dependent life insurance or AD&D insurance. Any
one of the following events may create a special open enrollment to enroll or
remove eligible dependents from PEBB health plan coverage:
(i) Subscriber acquires a new dependent due
to:
* Marriage or registering a state registered domestic
partnership;
* Birth, adoption, or when a subscriber has assumed a legal
obligation for total or partial support in anticipation of adoption; or
* A child becoming eligible as an extended dependent through
legal custody or legal guardianship.
(ii) Subscriber or a subscriber's dependent
loses other coverage under a group health plan or through health insurance
coverage, as defined by the Health Insurance Portability and Accountability Act
(HIPAA);
(iii) Subscriber has a
change in employment status that affects the subscriber's eligibility for their
employer contribution toward their employer-based group health plan;
(iv) The subscriber's dependent has a change
in their own employment status that affects their eligibility or their
dependent's eligibility for the employer contribution under their
employer-based group health plan;
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Note:
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As used in (iv) of this subsection, "employer
contribution" means contributions made by the dependent's current or former
employer toward health coverage as described in Treasury Regulation
54.9801-6.
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(v)
Subscriber or a subscriber's dependent has a change in enrollment under an
employer-based group health plan during its annual open enrollment that does
not align with the PEBB program's annual open enrollment;
(vi) Subscriber's dependent has a change in
residence from outside of the United States to within the United States, or
from within the United States to outside of the United States and that change
in residence resulted in the dependent losing their health insurance;
(vii) A court order requires the subscriber
or any other individual to provide insurance coverage for an eligible dependent
of the subscriber (a former spouse or former state registered domestic partner
is not an eligible dependent);
(viii) Subscriber or a subscriber's dependent
enrolls in coverage under medicaid or a state children's health insurance
program (CHIP), or the subscriber or a subscriber's dependent loses eligibility
for coverage under medicaid or CHIP;
(ix) Subscriber or a subscriber's dependent
becomes eligible for state premium assistance subsidy for PEBB health plan
coverage from medicaid or CHIP;
(x)
Subscriber's dependent enrolls in medicare, or loses eligibility for
medicare.
(4)
Enrollment requirements. A subscriber must submit the required forms
within the time frames described in this subsection. For PEBB health
plan coverage, an employee must submit the required forms to their employing
agency, any other subscriber must submit the required forms to the PEBB
program. In addition to the required forms indicating dependent enrollment, the
subscriber must provide the required documents as evidence of the dependent's
eligibility; or as evidence of the event that created the special open
enrollment. All required forms and documents must be received within the
required time frames. An employee enrolling a dependent in supplemental
dependent life insurance or AD&D insurance must submit the required form to
the contracted vendor for approval within the required time frames.
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Note:
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When enrolling a state registered domestic partner or
a state registered domestic partner's child, a subscriber must certify that the
state registered domestic partner or state registered domestic partner's child
is a tax dependent on the required form; otherwise, the PEBB program will
assume the state registered domestic partner or state registered domestic
partner's child is not a tax dependent.
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(a) If a
subscriber wants to enroll their eligible dependents in PEBB health plan
coverage when the subscriber becomes eligible to enroll in PEBB benefits, the
subscriber must include the dependent's enrollment information on the required
forms and submit them within the required time frame described in WAC
182-08-197,
182-12-171,
182-12-180,
182-12-211, 182-12-232, or
182-12-250. If an employee
enrolls a dependent in supplemental dependent life insurance or AD&D
insurance, the required form must be submitted within the required time frame
described in WAC
182-08-197.
(b) If a subscriber wants to enroll eligible
dependents in PEBB health plan coverage during the PEBB annual open enrollment
period, the required forms must be received no later than the last day of the
annual open enrollment.
(c) If a
subscriber wants to enroll newly eligible dependents, the required forms must
be received no later than 60 days after the dependent becomes eligible. An
employee enrolling a dependent in supplemental dependent life insurance or
AD&D insurance must submit the required form to the contracted vendor for
approval. An employee may enroll a dependent in supplemental dependent life
insurance up to the guaranteed issue coverage amount without evidence of
insurability if the required form is submitted to the contracted vendor as
required. Evidence of insurability will be required for supplemental dependent
life insurance over the guaranteed issue coverage amount. Evidence of
insurability is not required for supplemental AD&D insurance.
(d) If a subscriber wants to enroll a newborn
or child whom the subscriber has adopted or has assumed a legal obligation for
total or partial support in anticipation of adoption in PEBB health plan
coverage, the subscriber should notify the PEBB program by submitting the
required forms as soon as possible to ensure timely payment of claims. If
adding the child increases the premium, the required forms must be received no
later than 60 days after the date of the birth, adoption, or the date the legal
obligation is assumed for total or partial support in anticipation of adoption.
An employee enrolling a dependent in supplemental dependent life insurance or
AD&D insurance must submit the required form to the contracted vendor for
approval no later than 60 days after the date of the birth, adoption, or the
date the legal obligation is assumed for total or partial support in
anticipation of adoption. A newly born child must be at least 14 days old
before supplemental dependent life insurance or AD&D insurance coverage can
become effective.
(e) If the
subscriber wants to enroll a child age 26 or older as a child with a disability
in PEBB health plan coverage, the required forms must be received no later than
60 days after the child reaches age 26 or within the relevant time frame
described in (a), (b), and (f) of this subsection. To recertify an enrolled
child with a disability, the required forms must be received by the PEBB
program or the contracted vendor by the child's scheduled PEBB health plan
coverage termination date.
(f) If
the subscriber wants to change a dependent's enrollment status in PEBB health
plan coverage during a special open enrollment, the required forms must be
received no later than 60 days after the event that creates the special open
enrollment.
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Exception:
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If the subscriber wants to change a dependent's
enrollment or disenrollment in a MA plan, a MA-PD plan, or the UMP Classic
medicare plan, the required forms must be received during a special enrollment
period as allowed under 42
C.F.R. Secs. 422.62(b) and
423.38(c).
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(g)
An employee may enroll a dependent in supplemental dependent life insurance or
AD&D insurance at any time during the calendar year by submitting the
required form to the contracted vendor for approval. Evidence of insurability
may be required for supplemental dependent life insurance but will not be
required for supplemental AD&D insurance.
Statutory
Authority:
RCW
41.05.160 and
2012 2nd sp.s. c
3 . WSR 13-22-019 (Admin. 2013-01),
§182-12-262, filed 10/28/13, effective 1/1/14. Statutory Authority:
RCW
41.05.160. WSR 12-20-022 (Order 2012-01),
§182-12-262, 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), §182-12-262,
filed 10/26/11, effective 1/1/12. Statutory Authority:
RCW
41.05.160. WSR 10-20-147 (Order 10-02),
§182-12-262, filed 10/6/10, effective 1/1/11; WSR 09-23-102 (Order 09-02),
§182-12-262, filed 11/17/09, effective 1/1/10; WSR 08-20-128 (Order
08-03), §182-12-262, filed 10/1/08, effective 1/1/09; WSR 08-09-027 (Order
08-01), §182-12-262, filed 4/8/08, effective 4/9/08. WSR 13-21-033,
§182-12-262, filed 10/9/2013, effective
11/9/2013
