Wash. Admin. Code § 182-12-142 - [Effective 1/1/2025] What options for continuation coverage are available to faculty and seasonal employees who are between periods of eligibility?
(1)
Faculty may continue any
combination of medical, dental, or vision, and may also continue life insurance
and accidental death and dismemberment (AD&D) insurance by self-paying the
premium and applicable premium surcharges set by the health care authority
(HCA), with no contribution from the employer, for a maximum of 12 months
between periods of eligibility. If life insurance or AD&D insurance is
elected, both basic life and basic AD&D insurance must be continued.
Employees who continue basic life insurance and basic AD&D insurance may
also continue supplemental life and AD&D insurance:
(a) The employee's election must be received
by the public employees benefits board (PEBB) program no later than 60 days
from the date the employee's PEBB health plan coverage ended or from the
postmark date on the election notice sent by the PEBB program, whichever is
later;
(b) The employee's first
premium payment and applicable premium surcharges are due to the 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). Premiums and applicable premium
surcharges associated with continuing PEBB medical must be made to the HCA as
well as premiums associated with continuing PEBB dental and PEBB vision.
Premiums associated with continuing life insurance and AD&D insurance
coverage must be made to the contracted vendor;
(c) Following the employee's first premium
payment, the employee must pay the premium amounts associated with PEBB
insurance coverage and applicable premium surcharges as premiums become due;
and
(d) If the employee's monthly
premium or applicable premium surcharges remain unpaid for 60 days from the
original due date, the employee's PEBB insurance coverage will be terminated
retroactive to the last day of the month for which the monthly premium and
applicable premium surcharges were paid as described in WAC
182-08-180(1)(c).
(2)
Benefits-eligible seasonal
employees may continue any combination of medical, dental, or vision,
and may also continue life insurance and AD&D insurance by self-paying the
premium and applicable premium surcharges set by the HCA, with no contribution
from the employer, for a maximum of 12 months between periods of eligibility.
If life insurance or AD&D insurance is elected, both basic life and basic
AD&D insurance must be continued. Employees who continue basic life
insurance and basic AD&D insurance may also continue supplemental life and
AD&D insurance:
(a) The employee's
election must be received by the PEBB program no later than 60 days from the
date the employee's PEBB health plan coverage ended or from the postmark date
on the election notice sent by the PEBB program, whichever is later;
(b) The employee's first premium payment and
applicable premium surcharges are due to the 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). Premiums and applicable premium
surcharges associated with continuing PEBB medical must be made to the HCA as
well as premiums associated with continuing PEBB dental and PEBB vision.
Premiums associated with continuing life insurance and AD&D insurance
coverage must be made to the contracted vendor;
(c) Following the employee's first premium
payment, the employee must pay the premium amounts associated with PEBB
insurance coverage and applicable premium surcharges as premiums become due;
and
(d) If the employee's monthly
premium or applicable premium surcharges remain unpaid for 60 days from the
original due date, the employee's PEBB insurance coverage will be terminated
retroactive to the last day of the month for which the monthly premium and
applicable premium surcharges were paid as described in WAC
182-08-180(1)(c).
(3)
COBRA. An employee who is no
longer eligible for continuation coverage as described in subsections (1) and
(2) of this section, but who has not used the maximum number of months allowed
under the federal Consolidated Omnibus Budget Reconciliation Act (COBRA), may
continue medical, dental, vision, or any combination of these benefits for the
remaining difference in months by self-paying the premium and applicable
premium surcharges set by the HCA under COBRA as described in WAC
182-12-146. The number of months
that a faculty or seasonal employee self-pays premiums under the criteria in
subsection (1) or (2) of this section will count toward the total months of
continuation coverage allowed under COBRA.
Notes
Statutory Authority: RCW 41.05.160. 10-20-147 (Order 10-02), §182-12-142, filed 10/6/10, effective 1/1/11; 09-23-102 (Order 09-02), §182-12-142, filed 11/17/09, effective 1/1/10.
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