How to determine eligibility

Find out if you are eligible for PEBB retiree benefits.

Determining eligibility

You may be eligible to enroll in PEBB plans if you are a retiring employee of a:

  • PEBB-participating employer group.
  • State agency.
  • State higher education institution.
  • Washington State school district or educational service district.

You may also be eligible to enroll in PEBB retiree insurance if you are an elected or full-time appointed state official of the legislative or executive branch of state government who voluntarily or involuntarily leaves public office.

To be eligible to enroll in PEBB retiree insurance, you must meet both the procedural requirements and all eligibility requirements of WAC 182-12-171.

Eligibility requirements

Certain eligibility requirements must be met to receive PEBB retiree coverage:

  1. You must enroll in or defer coverage no later than 60 days after your employer-paid or COBRA coverage ends. If you do not submit an application to enroll in or defer coverage within your 60-day window, you lose all rights to enroll in PEBB retiree coverage in the future. To regain eligibility, you would have to return to work in a PEBB benefits eligible position.
  2. You must be vested in a Washington State-sponsored retirement plan. Washington State-sponsored retirement plans include:
    1. Public Employees’ Retirement System (PERS) 1, 2, or 3
    2. Public Safety Employees’ Retirement System (PSERS) 2
    3. Teachers Retirement System (TRS) 1, 2, or 3
    4. Washington Higher Education Retirement Plan (for example, TIAA-CREF)
    5. School Employees’ Retirement System (SERS) 2 and 3
    6. Law Enforcement Officers’ and Fire Fighters’ Retirement System (LEOFF) 1 or 2
    7. Washington State Patrol Retirement System (WSPRS) 1 or 2
    8. State Judges/Judicial Retirement System
    9. Civil Service Retirement System and Federal Employees’ Retirement System are considered a Washington State-sponsored retirement system for Washington State University Extension employees covered under PEBB insurance at the time of retirement or disability.
  3. Department of Retirement Systems (DRS) Plan 1 and 2 members must immediately receive a monthly retirement plan payment or lump sum payment as allowed by the plan. DRS Plan 3 members are not required to receive a retirement plan or lump sum payment, but must be at least age 55 and have at least 10 years of service under Plan 3.
    1. If you are an elected or a full-time appointed official of the legislative or executive branches of state government, you do not have to meet the age and years of service requirement or receive a monthly retirement plan payment from a state-sponsored retirement system.

Family member eligibility

You may enroll the following family members (dependents) as described in WAC 182-12 260:

The PEBB Program verifies the eligibility of all dependents and will request proof of a dependent’s eligibility. We will not enroll a dependent if we cannot verify the dependent’s eligibility. See Dependent verification.

If I die, are my surviving dependents eligible?

As an eligible retiree, your surviving spouse, state-registered domestic partner, or child may be eligible to enroll in PEBB retiree insurance if they meet both the procedural and eligibility requirements outlined in WAC 182-12-265. See COBRA/Continuation Coverage (LWOP) eligibility and enrollment.

Eligibility for survivors of emergency service employees

If you are a surviving spouse, state-registered domestic partner, or dependent child of an emergency service employee who was killed in the line of duty, you may be eligible to enroll in PEBB retiree insurance if you meet both the procedural and eligibility requirements outlined in WAC 182-12-250. All required forms enrolling or deferring retiree insurance coverage must be received by the PEBB Program no later than 180 days after the later of:

  • The death of the emergency service worker.
  • The date on the letter from the Department of Retirement Systems or the board for volunteer firefighters and reserve officers that informs the survivor that he or she is determined to be an eligible survivor.
  • The last day the surviving spouse, state-registered domestic partner, or child was covered under any health plan through the emergency service worker’s employer.
  • The last day the surviving spouse, state-registered domestic partner, or child was covered under the Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage from the emergency service worker’s employer.

What happens when a dependent loses eligibility?

You must notify the PEBB Program in writing when your dependent is no longer eligible. We must receive notice no later than 60 days after the date your dependent is no longer eligible.

Definition of children

Children are defined as your biological children, stepchildren, legally adopted children, children for whom you have assumed a legal obligation for total or partial support in anticipation of adoption, children of your state-registered domestic partner, children specified in a court order or divorce decree, or children defined in Washington State statutes that establish the parent-child relationship.

Children may also include extended dependents in your spouse’s or your state-registered domestic partner’s legal custody or legal guardianship. An extended dependent may be your grandchild, niece, nephew, or other child for whom you, your spouse, or state-registered domestic partner have legal responsibility as shown by a valid court order and the child’s official residence with the custodian or guardian. This does not include foster children for whom support payments are made to you through the state Department of Social and Health Services (DSHS) foster care program.

Eligible children with disabilities

Eligible children also include children of any age with a developmental disability or physical handicap that renders the child incapable of self-sustaining employment and chiefly dependent upon the employee for support and ongoing care, provided the condition occurred before age 26. You must provide evidence of the disability and evidence the condition occurred before age 26. The PEBB Program or its contracted medical plans will verify the disability and dependency of a child with a disability periodically beginning at age 26.

A child with a developmental disability or physical handicap who becomes self-supporting is not eligible as a child as of the last day of the month he or she becomes capable of self-support. If the child becomes capable of self-support and later becomes incapable of self-support, the child does not regain eligibility as a child with a disability.