Wash. Admin. Code § 182-12-113 - What are the obligations of a state agency in the application of employee eligibility?

(1) All state agencies must carry out all actions, policies, and guidance issued by the public employees benefits board (PEBB) program necessary for the operation of benefit plans, education of employees, claims administration, and appeals process including those described in chapters 182-08, 182-12, and 182-16 WAC. State agencies must:

(a) Use the methods provided by the PEBB program to determine eligibility and enrollment in benefits, unless otherwise approved in writing;

(b) Provide eligibility determination reports with content and in a format designed and communicated by the PEBB program or otherwise as approved in writing by the PEBB program; and

(c) Carry out corrective action and pay any penalties imposed by the authority and established by the board when the state agency's eligibility determinations fail to comply with the criteria under these rules.

(2) All state agencies must determine employee eligibility for PEBB benefits and the employer contribution according to the criteria in WAC 182-12-114 and 182-12-131. State agencies must:

(a) Notify newly hired employees of PEBB program rules and guidance for eligibility and appeal rights;

(b) Provide written notice to faculty who are potentially eligible for benefits and employer contribution of their potential eligibility as described in WAC 182-12-114(3) and 182-12-131;

(c) Inform an employee in writing whether or not they are eligible for PEBB benefits upon employment. The written notice must include a description of any hours that are excluded in determining eligibility and information about the employee's right to appeal eligibility and enrollment decisions. An employee eligible for PEBB benefits must have no less than 10 calendar days after the date of notice to elect coverage;

(d) Routinely monitor all employees' eligible work hours to establish eligibility and maintain the employer contribution toward PEBB benefits;

(e) Make eligibility determinations based on the criteria of the eligibility category that most closely describes the employee's work circumstances per the PEBB program's direction;

(f) Identify when a previously ineligible employee becomes eligible or a previously eligible employee loses eligibility; and

(g) Inform an employee in writing whether or not they are eligible for PEBB benefits and the employer contribution whenever there is a change in work pattern such that the employee's eligibility status changes. Whenever this occurs, state agencies must inform the employee of the right to appeal eligibility and enrollment decisions. An employee eligible for PEBB benefits must have no less than 10 calendar days after the date of notice to elect coverage.

(3) State agencies must determine employee's dependents eligibility for PEBB health plan coverage according to the criteria in WAC 182-12-260.

(4) State agencies must assist an employee in determining whether or not the employee or their dependent has experienced an event that creates a special open enrollment as described in WAC 182-08-198, 182-08-199, 182-12-128, or 182-12-262, and inform the employee of the changes they can make consistent with that event.

Notes

Wash. Admin. Code § 182-12-113

Amended by WSR 16-20-080, Filed 10/4/2016, effective 1/1/2017 Amended by WSR 18-20-117, Filed 10/3/2018, effective 1/1/2019 Amended by WSR 19-17-073, Filed 8/20/2019, effective 1/1/2020 Amended by WSR 20-16-062, Filed 7/28/2020, effective 1/1/2021 Amended by WSR 23-14-015, Filed 6/23/2023, effective 1/1/2024

Statutory Authority: RCW 41.05.160. 12-20-022 (Order 2012-01), §182-12-113, filed 9/25/12, effective 11/1/12; 09-23-102 (Order 09-02), §182-12-113, filed 11/17/09, effective 1/1/10.