Change your coverage

Learn the requirements to make changes to your PEBB retiree coverage.

Before you make a change

Before you make a change it is important to:

  • Make sure the health plan is available in your area.
  • Check the plan’s provider directory or contact your plan to make sure your provider is in the plan’s network.
  • Compare monthly plan costs (premiums).
  • Compare benefits and your costs for care (deductibles, coinsurance, and/or copays.)

How to make changes

To make changes, such as enroll a dependent or elect a different health plan, you must complete and submit the required form(s) during the annual open enrollment or when a special open enrollment event occurs, within the timelines listed below.

To make a change during the PEBB Program’s annual open enrollment from November 1-30:
The PEBB Program must receive the appropriate Retiree forms between November 1-30. You may also make some changes using My Account. The forms will not be available until November 1.

To make a change when a special open enrollment event occurs:
The PEBB Program must receive the appropriate Retiree Coverage Election/Change form (Form A) no later than 60 days after the event that created the special open enrollment. However, if adding a newborn or newly adopted child, and adding the child increases your premium, your employer must receive this form no later than 12 months after the birth or adoption.

Note: Retiree subscribers may voluntarily remove an eligible dependent from insurance coverage any time during the year.

In most cases, the change will occur the first day of the month after the date of the event or the date the PEBB Program receives your required, completed enrollment form(s), whichever is later. If that day is the first of the month, coverage begins on that date.

Changes you can make any time

There are some changes you can make any time during the year without a special open enrollment event.

Plan change requirements

  • You can only change medical or dental plans during the PEBB Program's annual open enrollment (November 1–30) of if you have a special open enrollment event.
  • All eligible family members must enroll in the same health plan. (Family members can have different providers.)
  • If you have a provider you want to stay with, contact your plan or check the plan’s provider directory to make sure your provider is in the plan’s network.
  • You cannot be enrolled on two PEBB accounts at the same time. If you and your spouse or state-registered domestic partner are both eligible subscribers, you need to choose which of you will cover yourselves and your eligible children (including adult children who are also eligible for PEBB coverage as an employee). Enrolled family members will be listed on one account, not both.

Special open enrollment

The PEBB Program allows changes outside of the PEBB Program annual open enrollment when certain events create a special open enrollment. The change must be on account of and correspond to the event that affects eligibility for coverage. You must provide proof of the event that created the special open enrollment (for example, a marriage or birth certificate).

Changes that may be allowed as a special open enrollment

If this event happens... Add dependent Change medical plan Change dental plan
Marriage, registering a state-registered domestic partnership, birth, adoption, or assuming a legal obligation for total or partial support in anticipation of adoption. Yes Yes Yes
Child becomes eligible as an extended dependent through legal custody or legal guardianship. Yes Yes Yes
Child becomes eligible as a dependent with a disability. Yes Yes Yes
Subscriber or dependent loses eligibility for other coverage under a group health plan or through health insurance, as defined by the Health Insurance Portability and Accountability Act (HIPAA). Yes Yes Yes
Subscriber has a change in employment status that affects his or her eligibility for the employer contribution under his or her employer-based group health plan. Yes Yes Yes
Subscriber's dependent has a change in his or her own employment status that affects his or her eligibility for the employer contribution under his or her employer-based group health plan. Yes Yes Yes
A court order or National Medical Support Notice requires the subscriber or any other individual to provide insurance coverage for an eligible dependent of the subscriber. Yes Yes Yes
Subscriber or a subscriber’s dependent becomes entitled to coverage or loses eligibility for Medicaid or a state Children’s Health Insurance Program (CHIP). Yes Yes Yes
Subscriber or a dependent becomes eligible for a state premium assistance subsidy for PEBB Program health plan coverage from Medicaid or CHIP. Yes Yes Yes
Subscriber's dependent has a change in enrollment under another employer-based group health plan during its annual open enrollment that does not align with the PEBB Program’s annual open enrollment. Yes No No
Subscriber’s dependent moves from outside the United States to live within the United States, or from within the United States to live outside of the United States. Yes No No
Subscriber or dependent has a change in residence that affects health plan availability. No Yes Yes
Subscriber or dependent experiences a disruption of care that could function as a reduction in benefits for the subscriber or his or her dependent for a specific condition or ongoing course of treatment (requires approval by the PEBB Program) No Yes Yes
Subscriber or dependent becomes entitled to Medicare or loses eligibility under Medicare; or enrolling (or cancelling enrollment) in a Medicare Part D plan. No Yes Yes
Subscriber’s or dependent’s current health plan becomes unavailable because the subscriber or enrolled dependent is no longer eligible for a health savings account (HSA) No Yes Yes

For more details, see PEBB Program Policy 45-2A and refer to Washington Administrative Code (WAC):

The PEBB Program's annual open enrollment

From November 1–30 each year, you can make changes to your PEBB account that will take effect January 1 of the following year.

During open enrollment you can:

Changes you can make online

During open enrollment you can make changes online using My Account. You can:

  • Change your medical and/or dental plan(s).
  • Waive medical coverage if you are enrolled in other employer-based group medical insurance coverage, TRICARE, or Medicare (coverage through the Health Benefit Exchange is not group coverage).
  • Remove family members from your coverage.

Please print or save your confirmation page when you’ve completed your changes. Check back in a two business days to verify the coverage you selected and your spousal or state-registered domestic partner coverage attestation is correct.

When you submit an online plan change, please wait two business days to make any additional online plan changes.