An employee who is eligible to participate in the salary
reduction plan may enroll or revoke their election and make a new election
under the premium payment plan, FSA, limited purpose FSA, or DCAP outside of
the annual open enrollment if a special open enrollment event occurs. The
enrollment or change in election must be allowable under Internal Revenue Code
(IRC) and Treasury regulations, and correspond to and be consistent with the
event that creates the special open enrollment. To make a change or enroll, the
employee must submit the required form to their employing agency. The employing
agency must receive the required form and evidence of the event that created
the special open enrollment no later than 60 days after the event occurs.
For purposes of this section, an eligible dependent includes
any person who qualifies as a dependent of the employee for tax purposes under
IRC 26 U.S.C. Sec.
152 without regard to the income limitations
of that section. It does not include a state registered domestic partner unless
the state registered domestic partner otherwise qualifies as a dependent for
tax purposes under IRC 26
U.S.C. Sec. 152.
(a)
Premium payment plan. An
employee may enroll or revoke their election and elect to opt out of the
premium payment plan when any of the following special open enrollment events
occur, if the requested change corresponds to and is consistent with the event.
The enrollment or election to opt out will be effective the first day 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 enrollment or change in
election begins on that day. If the special open enrollment is due to the
birth, adoption, or assumption of legal obligation for total or partial support
in anticipation of adoption of a child, the enrollment or change in election
will begin the first of the month in which the event occurs.
(i) Employee acquires a new dependent due to:
* Marriage;
* Registering a state registered domestic partnership when
the dependent is a tax dependent of the employee;
* Birth, adoption, or when the employee 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) Employee's dependent no longer meets
public employee benefits board (PEBB) eligibility criteria because:
* Employee has a change in marital status;
* Employee's domestic partnership with a state registered
domestic partner who is a tax dependent is dissolved or terminated;
* An eligible dependent child turns age 26 or otherwise does
not meet dependent child eligibility criteria;
* An eligible dependent ceases to be eligible as an extended
dependent or as a dependent with a disability; or
* An eligible dependent dies.
(iii) Employee or an employee'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);
(iv) Employee has a change
in employment status that affects the employee's eligibility for their employer
contribution toward their employer-based group health plan;
(v) The employee'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 (a)(v) of this subsection, "employer
contribution" means contributions made by the dependent's current or former
employer toward health coverage as described in Treasury Regulation
26 C.F.R.
54.9801-6.
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(vi)
Employee or an employee'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 annual open enrollment;
(vii) Employee or an employee's dependent has
a change in residence that affects health plan availability. If the employee
has a change in residence and the employee's current medical plan is no longer
available, the employee must select a new medical plan as described in WAC
182-08-196(3);
(viii) Employee'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;
(ix) A court order requires the employee 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);
(x)
Employee or an employee'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;
(xi) Employee or an
employee's dependent becomes eligible for state premium assistance subsidy for
PEBB medical plan coverage from medicaid or CHIP;
(xii) Employee or an employee's dependent
enrolls in coverage under medicare or the employee or an employee's dependent
loses eligibility for coverage under medicare;
(xiii) Employee or an employee's dependent's
current medical plan becomes unavailable because the employee or enrolled
dependent is no longer eligible for a health savings account (HSA). The health
care authority (HCA) requires evidence that the employee or employee's
dependent is no longer eligible for an HSA;
(xiv) Employee or an employee's dependent
experiences a disruption of care for active and ongoing treatment, that could
function as a reduction in benefits for the employee or the employee's
dependent. The employee may not change their health plan election if the
employee's or dependent's physician stops participation with the employee's
health plan unless the PEBB program determines that a continuity of care issue
exists. The PEBB program will consider but not limit its consideration to the
following:
* Active cancer treatment such as chemotherapy or radiation
therapy;
* Treatment following a recent organ transplant;
* A scheduled surgery;
* Recent major surgery still within the postoperative period;
or
* Treatment for a high-risk pregnancy.
(xv) Employee or employee's dependent becomes
eligible and enrolls in a TRICARE plan, or loses eligibility for a TRICARE
plan;
(xvi) The PEBB program
determines that there has been a substantial decrease in the providers
available under a PEBB medical plan.
If the employee is having premiums taken from payroll on a
pretax basis, a medical plan change will not be approved if it would conflict
with provisions of the salary reduction plan authorized under
RCW
41.05.300.
(b)
FSA and limited purpose FSA.
An employee may enroll or revoke their election and make a new election under
the FSA or limited purpose FSA when any one of the following special open
enrollment events occur, if the requested change corresponds to and is
consistent with the event. The enrollment or new election will be effective the
first day of the month following the later of the event date or the date the
required form and evidence of the event that created the special open
enrollment is received by the employing agency. If that day is the first of the
month, the enrollment or change in election begins on that day. If the special
open enrollment is due to the birth, adoption, or assumption of legal
obligation for total or partial support in anticipation of adoption of a child,
the enrollment or change in election will begin the first of the month in which
the event occurs.
(i) Employee acquires a new
dependent due to:
* Marriage;
* Registering a state registered domestic partnership if the
domestic partner qualifies as a tax dependent of the employee;
* Birth, adoption, or when the employee 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) Employee's dependent no longer meets
PEBB eligibility criteria because:
* Employee has a change in marital status;
* Employee's domestic partnership with a state registered
domestic partner who qualifies as a tax dependent is dissolved or
terminated;
* An eligible dependent child turns age 26 or otherwise does
not meet dependent child eligibility criteria;
* An eligible dependent ceases to be eligible as an extended
dependent or as a dependent with a disability; or
* An eligible dependent dies.
(iii) Employee or an employee's dependent
loses other coverage under a group health plan or through health insurance
coverage, as defined by the HIPAA;
(iv) Employee or an employee's dependent has
a change in employment status that affects the employee's or a dependent's
eligibility for the FSA or limited purpose FSA;
(v) A court order requires the employee 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);
(vi)
Employee or an employee's dependent enrolls in coverage under medicaid or a
state children's health insurance program (CHIP), or the employee or an
employee's dependent loses eligibility for coverage under medicaid or
CHIP;
(vii) Employee or an
employee's dependent enrolls in coverage under medicare.
(c)
DCAP. An employee may enroll
or revoke their election and make a new election under the DCAP when any one of
the following special open enrollment events occur, if the requested change
corresponds to and is consistent with the event. The enrollment or new election
will be effective the first day of the month following the later of the event
date or the date the required form and evidence of the event that created the
special open enrollment is received by the employing agency. If that day is the
first of the month, the enrollment or change in election begins on that day. If
the special open enrollment is due to the birth, adoption, or assumption of
legal obligation for total or partial support in anticipation of adoption of a
child, the enrollment or change in election will begin the first of the month
in which the event occurs.
(i) Employee
acquires a new dependent due to:
* Marriage;
* Registering a state registered domestic partnership if the
domestic partner qualifies as a tax dependent of the employee;
* Birth, adoption, or when the 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) Employee or an employee's dependent has
a change in employment status that affects the employee's or a dependent's
eligibility for DCAP;
(iii)
Employee or an employee's dependent has a change in enrollment under an
employer-based DCAP during its annual open enrollment that does not align with
the PEBB annual open enrollment;
(iv) Employee changes dependent care
provider; the change to the DCAP election amount can reflect the cost of the
new provider;
(v) Employee or the
employee's spouse experiences a change in the number of qualifying individuals
as defined in IRC 26 U.S.C.
Sec.
21 (b)(1);
(vi) Employee's dependent care provider
imposes a change in the cost of dependent care; employee may make a change in
the DCAP election amount to reflect the new cost if the dependent care provider
is not a qualifying relative of the employee as defined in IRC
26 U.S.C. Sec.
152.
