Waiving medical coverage

You can waive PEBB medical coverage if you are enrolled in other employer-based group medical insurance, TRICARE, or Medicare.

How do I waive coverage?

To waive enrollment in medical, your employer must receive your completed Employee Enrollment/Change form indicating that you want to waive enrollment in medical no later than 31 days after the date you become eligible for PEBB benefits (this is generally the first day of employment), or during an annual or special open enrollment.

If your employer offers PEBB dental, basic life, and basic long-term disability insurance (if eligible), you must enroll in these coverages for yourself, regardless of whether you waive PEBB medical.

If you waive PEBB medical:

  • You cannot enroll your eligible dependents in PEBB medical.
  • The premium surcharges will not apply to you.
  • You will not be eligible for the $125 SmartHealth wellness incentive.

What if I’m already enrolled in PEBB coverage?

If you are a newly eligible employee who is already enrolled in PEBB coverage as a dependent under your spouse’s, state-registered domestic partner’s, or parent’s account, you may either choose to:

  • Waive PEBB medical, and stay enrolled in medical under your spouse’s, state-registered domestic partner’s, or parent’s account.
    You must still enroll in PEBB dental, basic life, and basic long-term disability insurance (if your employer offers them) under your own account

    In addition, if you are enrolled in dental coverage under your spouse, state-registered domestic partner, or parent, he or she must also complete and submit the Employee Enrollment/Change form or Retiree Coverage Election/Change form to remove you from their dental coverage to prevent dual enrollment in dental coverage.

    OR

  • Enroll in PEBB medical under your own account.
    In addition, your spouse, state-registered domestic partner, or parent will also need to complete and submit the appropriate enrollment/change form(s) to remove you from their account to prevent dual medical and/or dental coverage.

How do I enroll after waiving coverage?

Once you waive PEBB coverage, you may reenroll. Your personnel, payroll, or benefits office must receive your completed Employee Enrollment/Change form before the end of the annual open enrollment period (November 1–30) or no later than 60 days after a special open enrollment event. In many instances, the date they receive your form affects the date that coverage begins, so you may want to turn the form in sooner. The PEBB Program will require you to provide proof of eligibility for any enrolled dependents and proof of the event that creates a special open enrollment. For more information, see WAC 182-12-128.

What happens if I don’t waive PEBB coverage?

If your personnel, payroll, or benefits office does not receive a completed enrollment form indicating your intent to waive medical coverage within the required timeframes, we will enroll you as a single subscriber in Uniform Medical Plan (UMP) Classic, and Uniform Dental Plan (UDP), basic life insurance, and basic long-term disability (LTD) insurance (if your employer offers these coverages). If defaulted as a single subscriber, you will owe medical premiums back to your effective date for PEBB benefits. Your dependents (if any) will not be enrolled.

What if I’m entitled to Medicare?

For employees and their enrolled spouses ages 65 and older, PEBB medical plans provide primary coverage, and Medicare coverage is ordinarily secondary. However, you may choose to waive your enrollment in PEBB medical and have Medicare as your coverage. However, you will remain enrolled in PEBB dental, life, and long-term disability coverage.

If you waive the PEBB medical plan, you can reenroll during the November annual open enrollment (for coverage effective January 1 of the following year) or if you have a special enrollment event that allows the change.