(1) The following
individuals may defer enrollment in public employees benefits board (PEBB)
retiree insurance coverage:
(a) A retiring
employee or a retiring school employee;
(b) A dependent becoming eligible as a
survivor; or
(c) A retiree or a
survivor enrolled in PEBB retiree insurance coverage.
(2) A subscriber described in subsection (1)
of this section who defers enrollment in PEBB retiree insurance coverage also
defers enrollment for all eligible dependents, except as described in
subsection (3)(c) of this section.
(3) When a subscriber described in subsection
(1) of this section chooses to defer enrollment in PEBB retiree insurance
coverage as described in (a) through (e) of this subsection, they must maintain
continuous enrollment in one or more qualifying coverages as described in (a)
through (e) of this subsection or WAC
182-12-200. A gap of 31 days or
less is allowed between the date PEBB retiree insurance coverage is deferred
and the start date of a qualifying coverage, and between each period of
enrollment in qualifying coverages during the deferral period. When a
subscriber chooses to defer enrollment in PEBB retiree insurance coverage as
described in (f) of this subsection; evidence of continuous enrollment in a
qualified coverage is waived as described in subsection (6)(f) of this section.
A subscriber who chooses to defer enrollment, defers
enrollment in PEBB medical, PEBB dental, and PEBB vision. A subscriber must be
enrolled in PEBB medical to enroll in PEBB dental except for a nonmedicare
retiree must enroll in PEBB medical to be able to enroll in PEBB dental, in
PEBB vision, or in both PEBB dental and PEBB vision. A retiree may only defer
enrollment in PEBB retiree term life insurance as described in WAC
182-12-209
(3)(b).
(a) Beginning January 1, 2001, enrollment in
PEBB retiree insurance coverage may be deferred when the subscriber is enrolled
in employer-based group medical as an employee or the dependent of an employee,
or such medical insurance continued under Consolidated Omnibus Budget
Reconciliation Act (COBRA) coverage or continuation coverage.
(b) Beginning January 1, 2001, enrollment in
PEBB retiree insurance coverage may be deferred when the subscriber is enrolled
as a retiree or the dependent of a retiree in a federal retiree medical
plan.
(c) Beginning January 1,
2006, enrollment in PEBB retiree insurance coverage may be deferred when the
subscriber is enrolled in medicare Parts A and B and a medicaid program that
provides creditable coverage as defined in WAC
182-12-109. Dependents may
continue their PEBB health plan enrollment if they meet PEBB eligibility
criteria and are not eligible for creditable coverage under a medicaid
program.
(d) Beginning January 1,
2014, subscribers who are not eligible for Parts A and B of medicare may defer
enrollment in PEBB retiree insurance coverage when the subscriber is enrolled
in exchange coverage.
(e) Beginning
July 17, 2018, enrollment in PEBB retiree insurance coverage may be deferred
when the subscriber is enrolled in the Civilian Health and Medical Program of
the Department of Veterans Affairs (CHAMPVA).
(f) Beginning January 1, 2025, subscribers
who are enrolled in medicare may defer enrollment in PEBB retiree insurance
coverage when they permanently live in a location outside of the United
States.
(4) To defer
enrollment in PEBB retiree insurance coverage, the required forms must be
submitted to the PEBB program.
(a) For a
retiring employee or a retiring school employee who meets the substantive
eligibility requirements as described in WAC
182-12-171(2),
enrollment will be deferred the first of the month following the date their own
employer-paid coverage, COBRA coverage, or continuation coverage ends. The
forms must be received by the PEBB program no later than 60 days after their
own employer-paid coverage, COBRA coverage, or continuation coverage
ends.
(b) For an official leaving
public office who meets the requirements as described in WAC
182-12-180(1),
enrollment will be deferred the first of the month following the date the
official leaves public office. The forms must be received by the PEBB program
no later than 60 days after the official leaves public office.
(c) For an employee or a school employee
determined to be retroactively eligible for disability retirement who meets the
requirements as described in WAC
182-12-211 (1)(a) through
(c), enrollment will be deferred as described
in WAC
182-12-211 (2) or
(3). The forms and formal determination
letter must be received by the PEBB program no later than 60 days after the
date on the determination letter.
(d) For an eligible survivor, the dependent
must meet the requirements described below and the forms must be received by
the PEBB program within the time described:
(i) For a survivor of an employee or a school
employee who meets the requirements as described in WAC
182-12-265 (1) or
(3), enrollment will be deferred the first of
the month following the later of the date of the employee's or the school
employee's death or the date the survivor's PEBB insurance coverage or school
employees benefits board (SEBB) insurance coverage ends. The forms must be
received by the PEBB program no later than 60 days after the later of the date
of the employee's or the school employee's death or the date the survivor's
PEBB insurance coverage or SEBB insurance coverage ends.
(ii) For a survivor of an official who meets
the requirements as described in WAC
182-12-180(2),
enrollment will be deferred the first of the month following the later of the
date of the official's death or the date the survivor's PEBB insurance coverage
ends. The forms must be received by the PEBB program no later than 60 days
after the later of the date of the official's death or the date the survivor's
PEBB insurance coverage ends.
(iii)
For a survivor of a retiree who meets the requirements as described in WAC
182-12-265(2),
enrollment will be deferred the first of the month following the date of the
retiree's death. The forms must be received by the PEBB program no later than
60 days after the retiree's death.
(iv) For a survivor of an emergency service
personnel killed in the line of duty who meets the requirements as described in
WAC
182-12-250, enrollment will be
deferred the first of the month following the later of one of the events
described in WAC
182-12-250 (5)(a) through
(d). The forms must be received by the PEBB
program no later than 180 days after the later of one of the events described
in WAC
182-12-250 (5)(a) through
(d).
(e) For an enrolled retiree or survivor who
submits the required forms to defer enrollment in PEBB retiree insurance
coverage, enrollment will be deferred effective the first of the month
following the date the required forms are received by the PEBB program. If the
forms are received on the first day of the month, enrollment will be deferred
effective that day.
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Exception:
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When a subscriber or their dependent is enrolled in a
medicare advantage (MA) plan, a medicare advantage-prescription drug (MA-PD)
plan, or the Uniform Medical Plan (UMP) Classic medicare plan, the enrollment
in PEBB retiree insurance coverage will be deferred effective the first of the
month following the date the plan disenrollment form is received.
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(5) A retiree who meets substantive
eligibility requirements in WAC
182-12-171(2)
and whose own employer-paid coverage, COBRA coverage, or continuation coverage
ended between January 1, 2001, and December 31, 2001, was not required to have
submitted the deferral form at that time, but must meet all procedural
requirements as stated in this section, WAC
182-12-171, and
182-12-200.
(6) A subscriber described in subsection (1)
of this section who defers enrollment as described in subsection (3)(a) through
(f) of this section may later enroll themselves and their dependents in a PEBB
health plan by submitting the required forms as described below. A subscriber
who defers enrollment as described in subsection (3)(a) through (e) of this
section must provide evidence of continuous enrollment in one or more
qualifying coverages as described in subsection (3)(a) through (e) of this
section. A gap of 31 days or less is allowed between the date PEBB retiree
insurance coverage is deferred and the start date of a qualifying coverage, and
between each period of enrollment in qualifying coverages during the deferral
period. A subscriber who defers enrollment as described in subsection (3)(f) of
this section must provide proof of enrollment in medicare parts A and B;
evidence of continuous enrollment in a qualified coverage is waived as
described in (f) of this subsection:
(a) A
subscriber who defers enrollment while enrolled in employer-based group medical
or such medical insurance continued under COBRA coverage or continuation
coverage may enroll in a PEBB health plan by submitting the required forms and
evidence of continuous enrollment to the PEBB program:
(i) During the PEBB annual open enrollment
period. The required forms must be received by the PEBB program no later than
the last day of the open enrollment period. PEBB health plan coverage begins
January 1st of the following year; or
(ii) When their employer-based group medical
or such coverage under COBRA coverage or continuation coverage ends. The
required forms and evidence of continuous enrollment must be received by the
PEBB program no later than 60 days after coverage ends. PEBB health plan
coverage begins the first day of the month after the employer-based group
medical coverage, COBRA coverage, or continuation coverage ends.
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Note:
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Enrollment in the PEBB program's MA plan, MA-PD plan,
or the 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 the 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) A subscriber who defers enrollment while
enrolled as a retiree or dependent of a retiree in a federal retiree medical
plan will have a one-time opportunity to enroll in a PEBB health plan by
submitting the required forms and evidence of continuous enrollment to the PEBB
program:
(i) During the PEBB annual open
enrollment period. The required forms must be received by the PEBB program no
later than the last day of the open enrollment period. PEBB health plan
coverage begins January 1st of the following year; or
(ii) When the federal retiree medical plan
coverage ends. The required forms and evidence of continuous enrollment must be
received by the PEBB program no later than 60 days after coverage ends. PEBB
health plan coverage begins the first day of the month after coverage under the
federal retiree medical plan ends.
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Note:
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Enrollment in the PEBB program's MA plan, MA-PD plan,
or the 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 the 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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(c) A subscriber who defers enrollment while
enrolled in medicare Parts A and B and a medicaid program that provides
creditable coverage as defined in WAC
182-12-109 may enroll in a PEBB
health plan by submitting the required forms and evidence of continuous
enrollment to the PEBB program:
(i) During the
PEBB annual open enrollment period. The required forms must be received by the
PEBB program no later than the last day of the open enrollment period. PEBB
health plan coverage begins January 1st of the following year; or
(ii) When their medicaid coverage ends. The
required forms and evidence of continuous enrollment must be received by the
PEBB program no later than 60 days after coverage ends. PEBB health plan
coverage begins the first day of the month after the medicaid coverage ends; or
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Note:
|
Enrollment in the PEBB program's MA plan, MA-PD plan,
or the 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 the 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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(iii)
No later than the end of the calendar year when their medicaid coverage ends if
the retiree or survivor was also determined eligible under
42 U.S.C. §
1395w-114 and subsequently enrolled in a
medicare Part D plan. Enrollment in the PEBB health plan will begin January 1st
following the end of the calendar year when the medicaid coverage ends. The
required forms must be received by the PEBB program no later than the last day
of the calendar year in which the medicaid coverage ends.
(d) A subscriber who defers enrollment while
enrolled in exchange coverage will have a one-time opportunity to enroll or
reenroll in a PEBB health plan by submitting the required forms and evidence of
continuous enrollment to the PEBB program:
(i) During the PEBB annual open enrollment
period. The required forms must be received by the PEBB program no later than
the last day of the open enrollment period. PEBB health plan coverage begins
January 1st of the following year; or
(ii) When exchange coverage ends. The
required forms and evidence of continuous enrollment must be received by the
PEBB program no later than 60 days after coverage ends. PEBB health plan
coverage begins the first day of the month after exchange coverage ends.
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Note:
|
Enrollment in the PEBB program's MA plan, MA-PD plan,
or the 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 the 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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(e) A subscriber who defers enrollment while
enrolled in CHAMPVA will have a one-time opportunity to enroll in a PEBB health
plan by submitting the required forms and evidence of continuous enrollment to
the PEBB program:
(i) During the PEBB annual
open enrollment period. The required forms must be received by the PEBB program
no later than the last day of the open enrollment period. PEBB health plan
coverage begins January 1st of the following year; or
(ii) When CHAMPVA coverage ends. The required
forms and evidence of continuous enrollment must be received by the PEBB
program no later than 60 days after coverage ends. PEBB health plan coverage
begins the first day of the month after CHAMPVA coverage ends.
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Note:
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Enrollment in the PEBB program's MA plan, MA-PD plan,
or the 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 the 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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(f) A subscriber enrolled in medicare who
defers enrollment while permanently living outside of the United States may
enroll in a PEBB health plan by submitting the required forms and proof of
enrollment in medicare parts A and B. Evidence of continuous enrollment in a
qualified coverage is waived while a subscriber enrolled in medicare lives
outside of the United States:
(i) During the
PEBB annual open enrollment period. The required forms must be received by the
PEBB program no later than the last day of the open enrollment period. PEBB
health plan coverage begins January 1st of the following year; or
(ii) When the subscriber permanently moved
back to the United States. The required forms and proof of enrollment in
medicare parts A and B must be received by the PEBB program no later than 60
days after the date of the permanent move or the date the subscriber provides
notification of such move, whichever is later. PEBB health plan coverage begins
the first day of the month after the permanent move or the date the subscriber
provides notification of such move, whichever is later.
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Note:
|
Enrollment in the PEBB program's MA plan, MA-PD plan,
or the 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 the 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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(7) A subscriber described in subsection (1)
of this section who defers enrollment as described in subsection (3)(a) through
(f) of this section may later enroll themselves and their dependents in a PEBB
health plan if they receive formal notice that the authority has determined it
is more cost-effective to enroll them or their eligible dependents in PEBB
medical than a medical assistance program.
(8) If a subscriber elects to enroll a
dependent in PEBB health plan coverage as described in subsection (6) or (7) of
this section, the dependent must be enrolled in the same PEBB medical and PEBB
dental plan as the subscriber.
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Exceptions:
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(1) If a subscriber 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 subscriber selects any other medicare
plan, they must also select a nonmedicare plan with the same contracted vendor
available to nonmedicare enrollees.
(2) If a subscriber 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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(9) A
nonmedicare subscriber 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.
(10)
An enrolled retiree or a survivor who requests to voluntarily terminate their
enrollment in PEBB retiree insurance coverage must do so in writing. The
written termination request must be received by the PEBB program. A retiree or
a survivor who voluntarily terminates their enrollment in a PEBB health plan
also terminates enrollment for all eligible dependents. Once coverage is
terminated, a retiree or a survivor may not enroll again in the future unless
they reestablish eligibility for PEBB insurance coverage by becoming newly
eligible. Enrollment in a PEBB health plan will terminate on the last day of
the month in which the PEBB program receives the termination request. If the
termination request is received on the first day of the month, enrollment will
terminate on the last day of the previous month.
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Exception:
|
When a subscriber or their dependent is enrolled in a
MA plan, a MA-PD plan, or the UMP Classic medicare plan, the enrollment will
terminate on the last day of the month when the plan disenrollment form is
received.
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(11)
When a retiree becomes eligible for the employer contribution toward PEBB or
SEBB benefits, PEBB retiree insurance coverage will be automatically deferred.
The subscriber will be exempt from the deferral form requirement.
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Note:
|
When the subscriber is no longer eligible for the
employer contribution toward PEBB or SEBB benefits, they may enroll in PEBB
retiree insurance coverage as described in WAC
182-12-171 or continue in a
deferred status if they meet the requirements described in WAC
182-12-200 or this
section.
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Notes
Wash. Admin.
Code §
182-12-205
Amended by
WSR
14-20-058, Filed 9/25/2014, effective
1/1/2015
Amended by
WSR
15-22-099, Filed 11/4/2015, effective
1/1/2016
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
20-16-063, Filed 7/28/2020, effective
1/1/2021
Amended by
WSR
21-13-104, Filed 6/18/2021, effective
1/1/2022
Amended by
WSR
22-13-165, Filed 6/21/2022, effective
1/1/2023
Amended by
WSR
23-14-015, Filed 6/23/2023, effective
1/1/2024
Amended by
WSR
24-18-083, Filed 8/29/2024, effective
1/1/2025
Statutory
Authority:
RCW
41.05.160 and
2012 2nd sp.s. c
3 . WSR 13-22-019 (Admin. 2013-01), §182-12-205,
filed 10/28/13, effective 1/1/14. Statutory Authority:
RCW
41.05.160. WSR 12-20-022 (Order 2012-01),
§182-12-205, 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), §182-12-205,
filed 10/26/11, effective 1/1/12. Statutory Authority:
RCW
41.05.160. WSR 10-20-147 (Order 10-02),
§182-12-205, filed 10/6/10, effective 1/1/11; WSR 09-23-102 (Order 09-02),
§182-12-205, filed 11/17/09, effective 1/1/10; WSR 08-20-128 (Order 08-03),
§182-12-205, filed 10/1/08, effective 1/1/09; WSR 08-09-027 (Order 08-01),
§182-12-205, filed 4/8/08, effective 4/9/08; WSR 07-20-129 (Order 07-01),
§182-12-205, filed 10/3/07, effective 11/3/07. Statutory Authority:
RCW
41.05.160 and
41.05.068. WSR 06-23-165 (Order
06-09), §182-12-205, filed 11/22/06, effective 12/23/06. Statutory Authority:
RCW
41.05.160,
41.05.350, and
41.05.165. WSR 05-16-046 (Order
05-01), §182-12-205, filed 7/27/05, effective 8/27/05. Statutory Authority:
RCW
41.05.160 and
41.05.165. WSR 04-18-039,
§182-12-205, filed 8/26/04, effective 1/1/05. WSR 13-21-033, §182-12-205, filed
10/9/2013, effective 11/9/2013
