How to determine eligibility

Find out if you're eligible for COBRA or continuation coverage (formerly LWOP) benefits.

What is continuation coverage?

Federal law requires that most group health plans (including the Public Employees Benefits Board [PEBB] Program) give employees and their families the opportunity to continue their health coverage when they lose coverage under an employer’s plan.

PEBB Continuation Coverage provides the same medical and dental benefits, choice of health plans, and cost-sharing (including annual deductibles, copays, and coinsurance) available to other PEBB enrollees who aren’t enrolled in continuation coverage.

Each person who elects PEBB Continuation Coverage will have the same rights as other PEBB enrollees, including annual open enrollment and special open enrollment rights.

Who is eligible for continuation coverage?

Once the PEBB Program receives notice that a qualifying event has occurred, it will offer continuation coverage to each qualified beneficiary. Each covered dependent who loses PEBB  health coverage will have an independent right to elect COBRA or PEBB continuation coverage (formerly leave without pay).

Dependents do not have independent election rights to continuation coverage. They can only be enrolled in continuation coverage if the employee enrolls in continuation coverage. Employees may choose continuation coverage on behalf of their spouses or state-registered domestic partners. Parents may choose continuation coverage on behalf of their children. Any qualified beneficiary who does not choose continuation coverage within the 60-day period specified in the Continuation Coverage Election Notice will lose his or her right to continuation coverage.

What continuation coverage options are available?

The PEBB Program offers several ways for eligible members to continue PEBB Program health plan coverage.

  1. Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage—A temporary extension of PEBB health plan coverage available to PEBB members defined as qualified beneficiaries under federal rules. Each qualified beneficiary may choose COBRA. Those choosing COBRA coverage must pay the premium. The type of qualifying event determines how long you may continue COBRA coverage.
  2. PEBB Program continuation coverage—Includes PEBB Continuation of Coverage. Continuation coverage is a temporary extension of PEBB health plan coverage as an alternative for PEBB members who are not qualified beneficiaries under COBRA coverage and for those individuals in specific situations. Monthly premiums are the same as for COBRA. Life and long-term disability (LTD) insurance have separate premiums you must pay if you choose to continue under continuation coverage.
  3. PEBB retiree insurance coverage—A continuation of PEBB health plan coverage available to employees and survivors who meet retiree eligibility and enrollment requirements. See Retiree eligibility and enrollment.

Who is eligible for COBRA?

You, your spouse (or former spouse), and your dependent children who lost PEBB health plan coverage due to a qualifying event listed below are qualified beneficiaries, and are entitled to COBRA.

You may choose to continue coverage you are enrolled in on the day before the qualifying event occurs (medical coverage only, dental coverage only, or both medical and dental coverage) by self-paying the premiums. If enrolled in a Medical Flexible Spending Arrangement (FSA), you can choose to continue it until the end of the plan year in which the qualifying event occurs.

Qualifying events for COBRA coverage

Employee

  • Your hours of employment are reduced below the number of hours required to be eligible for the employer contribution toward health care coverage.
  • Your employment ends for any reason other than gross misconduct.

Retiree

  • Your employer group ends participation in PEBB health coverage. (Retirees of school districts and educational service districts can continue their PEBB retiree coverage, even if their district discontinues participation or never participated with the PEBB Program.)
  • The Department of Retirement Systems (DRS) determines you are no longer disabled, so your pension stops.

Spouse

  • Your spouse (the employee or retiree) dies, and you don’t qualify for PEBB retiree insurance coverage as a surviving spouse.
  • Your spouse’s (the employee’s) hours of employment are reduced.
  • Your spouse’s (the employee’s) employment ends for any reason other than for gross misconduct.
  • You divorce. If your spouse (the employee or retiree) reduces or cancels your PEBB health plan coverage in anticipation of a divorce, the divorce may be considered a qualifying event even though you lost coverage before the divorce was final.

Dependent children

  • Your parent (the employee or retiree) dies, and you don’t qualify for PEBB retiree insurance coverage as a surviving dependent.
  • Your parent (the employee’s) hours of employment are reduced.
  • Your parent (the employee’s) employment ends for any reason other than gross misconduct.
  • Your eligibility for PEBB coverage as a dependent child ends.

Children born to or placed for adoption with the covered employee during the COBRA coverage period

A child born to, adopted by, or placed for adoption with a covered employee during a period of COBRA coverage is considered a qualified beneficiary. The child’s COBRA coverage begins when the child is enrolled in PEBB coverage, whether through a special open enrollment or annual open enrollment, and lasts for the duration of the COBRA coverage period, measured from the original qualifying event date. To be enrolled in PEBB health coverage, the child must otherwise satisfy PEBB eligibility requirements.

Alternate recipients under National Medical Support Notice (NMSN) or court order

A child of the covered employee who is receiving benefits pursuant to a NMSN or court order, received by the employer or the PEBB during the covered employee’s period of employment, is entitled to the same rights to COBRA coverage as an eligible dependent child of the covered employee.

Who is eligible for PEBB Continuation Coverage?

Your state-registered domestic partner (or former domestic partner) and their children who lost PEBB health plan coverage due to the events below are entitled to independent election rights under PEBB Continuation Coverage. They may continue the same benefits available to COBRA members.

Qualifying events for PEBB Continuation Coverage

State-registered domestic partner

  • Your state-registered domestic partner (the employee or retiree) dies, and you do not qualify for PEBB retiree insurance coverage as a surviving state-registered domestic partner.
  • Your state-registered domestic partner (the employee’s) hours of employment are reduced.
  • Your state-registered domestic partner (the employee’s) employment ends for any reason other than gross misconduct.
  • Your state-registered domestic partnership is terminated. If your state-registered domestic partner (the employee or retiree) reduces or cancels your PEBB health plan coverage in anticipation of the domestic partnership’s termination, the domestic partnership termination may be considered a qualifying event even though you lost coverage before the legal termination of the state-registered domestic partnership was final.

State-registered domestic partner's children

  • Your parent’s state-registered domestic partner (the employee or retiree) dies, and you don’t qualify for PEBB retiree insurance coverage as a surviving dependent.
  • Your parent’s state-registered domestic partner (the employee’s) hours of employment are reduced.
  • Your parent’s state-registered domestic partner (the employee’s) employment ends for any reason other than gross misconduct.
  • Your eligibility for PEBB coverage as a dependent child ends.

Who is eligible for PEBB continuation coverage (LWOP)?

As an employee who lost PEBB insurance coverage (LWOP) due to one of the events listed below, you are entitled to PEBB continuation coverage (LWOP coverage). Employees may continue medical and dental benefits, Medical Flexible Spending Arrangement (FSA), life insurance, and in some cases, long-term disability insurance. You must enroll in continuation coverage to enroll your eligible dependents. Your eligible dependents do not have independent election rights to continuation coverage.

Qualifying events for PEBB continuation coverage (LWOP)

Employee

  • You are on authorized leave without pay from your agency.
  • Your employment ends due to a layoff.
  • You reverted to a position that is not eligible for the employer contribution toward insurance coverage.
  • You are appealing a dismissal action.
  • You are receiving time-loss benefits under workers' compensation.
  • You are applying for disability retirement.
  • You are called to active duty in the uniformed services, as defined under the Uniformed Services Employment and Reemployment Rights Act (USERRA).*
  • You are on approved educational leave.*
  • You are a faculty member who is between periods of eligibility.
  • You are a seasonal employee who is between periods of eligibility.

* You may also be entitled to continue long-term disability insurance.

What is a qualified beneficiary?

A qualified beneficiary is an employee, spouse, or dependent child who lost PEBB health coverage due to a qualifying event and may choose COBRA coverage. State-registered domestic partners and their children who lost PEBB health coverage due to the same types of events may choose PEBB continuation coverage, which is an alternative created for PEBB members who are not qualified beneficiaries under COBRA. When the PEBB Program uses the term "qualified beneficiary" it also applies to state-registered domestic partners and their children who lost PEBB health coverage due to the same types of events. Exception: You must be an employee, spouse, or qualified tax dependent to be eligible to continue a Medical Flexible Spending Arrangement (FSA).

What if I decline continuation coverage?

If you decline continuation coverage before the due date, your PEBB coverage will end on the last day of the month you and your family member(s) stop being eligible. You may change your mind as long as you mail or hand-deliver a completed election form no later than 60 days from the date you receive the Initial Notice of COBRA and Continuation Coverage Rights.