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        • What are my basic covered services?
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      • Other Apple Health programs
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      • Learn about my coverage
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      • Prenatal, children & young adults
        • Behavioral health services for prenatal, children & young adults
        • Wraparound with Intensive Services (WISe)
        • Family initiated treatment (FIT)
        • Early signs of psychosis
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        • What is recovery support?
        • Peer support & counseling
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      • Prevention
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    • I help others apply for & access Apple Health
      • Apple Health Eligibility Manual
        • Apple Health eligibility manual overview
        • Introduction overview for general eligibility
        • General eligibility requirements that apply to all Apple Health programs
        • Classic (non-MAGI) based programs manual
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      • Apply for or renew Apple Health coverage
      • Apple Health for you
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      • Get help paying for prescriptions
      • Behavioral health facilities complaints
      • Ombuds services
      • General eligibility introduction
      • ​Program standard for income & resources
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      MM - Footer
      • Contact Apple Health (Medicaid)
      • News
      • Apple Health Eligibility Manual
        • Apple Health eligibility manual overview
        • Introduction overview for general eligibility
        • General eligibility requirements that apply to all Apple Health programs
        • Classic (non-MAGI) based programs manual
        • Modified Adjusted Gross Income (MAGI) based programs manual
        • Long-term services & supports (LTSS) manual
      • Additional tools
        • Apple Health manual WAC index
        • Apple Health manual revision log
        • Program standards for income & resources
      • Stakeholder training & education
        • Training & education overview
        • Community-based training
        • Reference guides
        • Webinars, videos & presentations
        • Apple Health outreach toolkit
        • COFA outreach toolkit
        • Hospital Presumptive Eligibility
        • Medicaid suspension
    • I need medical, dental, or vision care
      • Find Apple Health benefits & services
        • What are my basic covered services?
        • How do I get dental care?
        • Can I get vision care?
        • Other benefits & services
        • What are my basic covered services?
        • How do I get dental care?
        • Can I get vision care?
        • Other benefits & services
      • Other Apple Health programs
        • Noncitizens
        • Apple Health Medicare Connect
        • Apple Health for Workers with Disabilities (HWD)
        • Family Planning Only (FPO)
        • Medically Intensive Children's Program (MICP)
        • Medicare Savings Program
        • Veterans & family members
      • Am I eligible?
        • Eligibility overview
        • Individual adults
        • Parents & caretakers
        • Pregnant individuals
        • Children
        • Age 65 & older, or Medicare eligible
        • Aged, blind, or disabled
        • Long-term care & hospice
        • Foster care
      • Learn about my coverage
        • Coverage with managed care
        • Coverage without managed care
        • American Indians & Alaska Natives
        • Coordination of benefits
        • Premium payment program
        • Patient review & coordination
        • Client rights
      • Use my coverage
        • How do I use my coverage?
        • Enrollment next steps
        • Make my first appointment
        • Transportation services (nonemergency)
        • Apple Health client booklets
      • Manage my coverage
        • Update my income or address
        • Log into my Apple Health accounts
        • Replace my services card
        • Change my health plan
        • Pay my Apple Health premium
        • Cancel my coverage
      Quick links
      • Apply for or renew Apple Health coverage
      • Apple Health for you
      • Apple Health account logins
      • Find forms & publications
      • Get help paying for prescriptions
      • Behavioral health facilities complaints
      • Ombuds services
      • General eligibility introduction
      • ​Program standard for income & resources
      • Voices of Apple Health
      • Voices of behavioral health & recovery
      MM - Footer
      • Contact Apple Health (Medicaid)
      • News
      • Find Apple Health benefits & services
        • What are my basic covered services?
        • How do I get dental care?
        • Can I get vision care?
        • Other benefits & services
        • What are my basic covered services?
        • How do I get dental care?
        • Can I get vision care?
        • Other benefits & services
      • Other Apple Health programs
        • Noncitizens
        • Apple Health Medicare Connect
        • Apple Health for Workers with Disabilities (HWD)
        • Family Planning Only (FPO)
        • Medically Intensive Children's Program (MICP)
        • Medicare Savings Program
        • Veterans & family members
      • Am I eligible?
        • Eligibility overview
        • Individual adults
        • Parents & caretakers
        • Pregnant individuals
        • Children
        • Age 65 & older, or Medicare eligible
        • Aged, blind, or disabled
        • Long-term care & hospice
        • Foster care
      • Learn about my coverage
        • Coverage with managed care
        • Coverage without managed care
        • American Indians & Alaska Natives
        • Coordination of benefits
        • Premium payment program
        • Patient review & coordination
        • Client rights
      • Use my coverage
        • How do I use my coverage?
        • Enrollment next steps
        • Make my first appointment
        • Transportation services (nonemergency)
        • Apple Health client booklets
      • Manage my coverage
        • Update my income or address
        • Log into my Apple Health accounts
        • Replace my services card
        • Change my health plan
        • Pay my Apple Health premium
        • Cancel my coverage
    • I need behavioral health support
      • Mental health
        • Mental health crisis lines
        • Mental health services
        • Acute mental health care
        • Problem gambling
        • Mental health advance directives
      • Substance use
        • Substance use treatment
        • Alcohol use treatment
        • Opioid use treatment
      • Prenatal, children & young adults
        • Behavioral health services for prenatal, children & young adults
        • Wraparound with Intensive Services (WISe)
        • Family initiated treatment (FIT)
        • Early signs of psychosis
        • Housing for transitioning youth
      • American Indians & Alaska Natives
        • Behavioral health services for American Indians & Alaska Natives (AI/AN)
      • Recovery support services
        • What is recovery support?
        • Peer support & counseling
        • Recovery housing
      • Prevention
        • Substance use disorder prevention & mental health promotion
      Quick links
      • Apply for or renew Apple Health coverage
      • Apple Health for you
      • Apple Health account logins
      • Find forms & publications
      • Get help paying for prescriptions
      • Behavioral health facilities complaints
      • Ombuds services
      • General eligibility introduction
      • ​Program standard for income & resources
      • Voices of Apple Health
      • Voices of behavioral health & recovery
      MM - Footer
      • Contact Apple Health (Medicaid)
      • News
      • Mental health
        • Mental health crisis lines
        • Mental health services
        • Acute mental health care
        • Problem gambling
        • Mental health advance directives
      • Substance use
        • Substance use treatment
        • Alcohol use treatment
        • Opioid use treatment
      • Prenatal, children & young adults
        • Behavioral health services for prenatal, children & young adults
        • Wraparound with Intensive Services (WISe)
        • Family initiated treatment (FIT)
        • Early signs of psychosis
        • Housing for transitioning youth
      • American Indians & Alaska Natives
        • Behavioral health services for American Indians & Alaska Natives (AI/AN)
      • Recovery support services
        • What is recovery support?
        • Peer support & counseling
        • Recovery housing
      • Prevention
        • Substance use disorder prevention & mental health promotion
    • I help others apply for & access Apple Health
      • Apple Health Eligibility Manual
        • Apple Health eligibility manual overview
        • Introduction overview for general eligibility
        • General eligibility requirements that apply to all Apple Health programs
        • Classic (non-MAGI) based programs manual
        • Modified Adjusted Gross Income (MAGI) based programs manual
        • Long-term services & supports (LTSS) manual
      • Additional tools
        • Apple Health manual WAC index
        • Apple Health manual revision log
        • Program standards for income & resources
      • Stakeholder training & education
        • Training & education overview
        • Community-based training
        • Reference guides
        • Webinars, videos & presentations
        • Apple Health outreach toolkit
        • COFA outreach toolkit
        • Hospital Presumptive Eligibility
        • Medicaid suspension
      Quick links
      • Apply for or renew Apple Health coverage
      • Apple Health for you
      • Apple Health account logins
      • Find forms & publications
      • Get help paying for prescriptions
      • Behavioral health facilities complaints
      • Ombuds services
      • General eligibility introduction
      • ​Program standard for income & resources
      • Voices of Apple Health
      • Voices of behavioral health & recovery
      MM - Footer
      • Contact Apple Health (Medicaid)
      • News
      • Apple Health Eligibility Manual
        • Apple Health eligibility manual overview
        • Introduction overview for general eligibility
        • General eligibility requirements that apply to all Apple Health programs
        • Classic (non-MAGI) based programs manual
        • Modified Adjusted Gross Income (MAGI) based programs manual
        • Long-term services & supports (LTSS) manual
      • Additional tools
        • Apple Health manual WAC index
        • Apple Health manual revision log
        • Program standards for income & resources
      • Stakeholder training & education
        • Training & education overview
        • Community-based training
        • Reference guides
        • Webinars, videos & presentations
        • Apple Health outreach toolkit
        • COFA outreach toolkit
        • Hospital Presumptive Eligibility
        • Medicaid suspension
  • Employee & retiree benefits
    • Public employees
      • Find benefits
        • Medical plans & benefits (including vision)
        • Dental plans & benefits
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        • Find a PEBB plan provider
        • Life, home, auto, AD&D, LTD, FSA, & DCAP benefits
        • PEBB wellness programs
        • Medicare & PEBB benefits while employed
      • Explore costs
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        • Change my coverage
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        • Accessing SmartHealth
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      • Log into PEBB My Account
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      MM - Footer
      • Contact us
      • PEBB news
      • Find benefits
        • Medical plans & benefits (including vision)
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        • Find a PEBB plan provider
        • Life, home, auto, AD&D, LTD, FSA, & DCAP benefits
        • PEBB wellness programs
        • Medicare & PEBB benefits while employed
      • Explore costs
        • Medical plan premiums
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        • Long-term disability insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • For newly eligible employees
        • Verify & enroll my dependents
        • Waive my medical coverage
      • For survivors
        • Defer as a survivor
        • Enroll as a survivor
        • How do I notify PEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
        • What happens if I stop working?
      • Get help
        • Contact the plans
        • Help with PEBB My Account
        • About Benefits 24/7
        • Accessing SmartHealth
    • School employees
      • Find benefits
        • Medical plans & benefits
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        • Vision plans & benefits
        • Benefits while traveling
        • Find a SEBB plan provider
        • Life, LTD, FSA, & DCAP benefits
        • SEBB wellness programs
        • Medicare & SEBB benefits while employed
      • Explore costs
        • Medical plan premiums
        • Life insurance premiums
        • Long-term disability insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • For newly eligible employees
        • Verify & enroll my dependents
        • Waive my medical coverage
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify SEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
        • What happens if I stop working?
      • Get help
        • Contact the plans
        • Help with SEBB My Account
        • About Benefits 24/7
        • Accessing SmartHealth
      Quick links
      • Find forms & publications
      • Retiree engagement
      • Preparing for retirement?
      • Public employees
      • Log into PEBB My Account
      • PEBB newsletters
      • Visit our PEBB Virtual Benefits Fair
      • File a PEBB appeal
      • PEBB rules & policies
      • PEB Board
      • School employees
      • Log into SEBB My Account
      • SEBB newsletters
      • Visit our SEBB Virtual Benefits Fair
      • File a SEBB appeal
      • SEBB rules and policies
      • SEB Board
      • For groups joining PEBB
      • For groups joining SEBB
      MM - Footer
      • Contact us
      • SEBB news
      • Find benefits
        • Medical plans & benefits
        • Dental plans & benefits
        • Vision plans & benefits
        • Benefits while traveling
        • Find a SEBB plan provider
        • Life, LTD, FSA, & DCAP benefits
        • SEBB wellness programs
        • Medicare & SEBB benefits while employed
      • Explore costs
        • Medical plan premiums
        • Life insurance premiums
        • Long-term disability insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • For newly eligible employees
        • Verify & enroll my dependents
        • Waive my medical coverage
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify SEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
        • What happens if I stop working?
      • Get help
        • Contact the plans
        • Help with SEBB My Account
        • About Benefits 24/7
        • Accessing SmartHealth
    • Retirees
      • Find benefits
        • Medical plans & benefits (including vision)
        • Dental plans & benefits
        • Benefits while traveling
        • Find a PEBB plan provider
        • Life, home & auto benefits
        • PEBB wellness programs
        • Medicare & turning age 65
      • Explore costs
        • Medicare plan premiums
        • Non-Medicare plan premiums
        • Life insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
        • Denied coverage? You may still be eligible.
      • Learn how to enroll
        • How do I enroll?
        • Attend a retirement webinar
        • Verify & enroll my dependents
      • Learn how & why to defer
        • What is deferring & why would I?
        • How do I defer?
        • How do I enroll after deferring?
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify PEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
      • Get help
        • Contact the plans
        • Help with PEBB My Account
        • About Benefits 24/7
        • Accessing SmartHealth
      Quick links
      • Find forms & publications
      • Retiree engagement
      • Preparing for retirement?
      • Public employees
      • Log into PEBB My Account
      • PEBB newsletters
      • Visit our PEBB Virtual Benefits Fair
      • File a PEBB appeal
      • PEBB rules & policies
      • PEB Board
      • School employees
      • Log into SEBB My Account
      • SEBB newsletters
      • Visit our SEBB Virtual Benefits Fair
      • File a SEBB appeal
      • SEBB rules and policies
      • SEB Board
      • For groups joining PEBB
      • For groups joining SEBB
      MM - Footer
      • Contact us
      • PEBB news
      • Find benefits
        • Medical plans & benefits (including vision)
        • Dental plans & benefits
        • Benefits while traveling
        • Find a PEBB plan provider
        • Life, home & auto benefits
        • PEBB wellness programs
        • Medicare & turning age 65
      • Explore costs
        • Medicare plan premiums
        • Non-Medicare plan premiums
        • Life insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
        • Denied coverage? You may still be eligible.
      • Learn how to enroll
        • How do I enroll?
        • Attend a retirement webinar
        • Verify & enroll my dependents
      • Learn how & why to defer
        • What is deferring & why would I?
        • How do I defer?
        • How do I enroll after deferring?
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify PEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
      • Get help
        • Contact the plans
        • Help with PEBB My Account
        • About Benefits 24/7
        • Accessing SmartHealth
    • PEBB Continuation Coverage
      • Find benefits
        • Medical plans & benefits (including vision)
        • Dental plans & benefits
        • Benefits while traveling
        • Find a PEBB plan provider
        • Life, home, auto, AD&D, LTD, & FSA benefits
        • PEBB wellness programs
      • Explore costs
        • Medicare plan premiums
        • Non-Medicare plan premiums
        • Life insurance premiums
        • Long term disability insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • For newly eligible members
        • Verify & enroll my dependents
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify PEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
      • Get help
        • Contact the plans
        • Help with PEBB My Account
        • About Benefits 24/7
        • Accessing SmartHealth
      Quick links
      • Find forms & publications
      • Retiree engagement
      • Preparing for retirement?
      • Public employees
      • Log into PEBB My Account
      • PEBB newsletters
      • Visit our PEBB Virtual Benefits Fair
      • File a PEBB appeal
      • PEBB rules & policies
      • PEB Board
      • School employees
      • Log into SEBB My Account
      • SEBB newsletters
      • Visit our SEBB Virtual Benefits Fair
      • File a SEBB appeal
      • SEBB rules and policies
      • SEB Board
      • For groups joining PEBB
      • For groups joining SEBB
      MM - Footer
      • Contact us
      • PEBB news
      • Find benefits
        • Medical plans & benefits (including vision)
        • Dental plans & benefits
        • Benefits while traveling
        • Find a PEBB plan provider
        • Life, home, auto, AD&D, LTD, & FSA benefits
        • PEBB wellness programs
      • Explore costs
        • Medicare plan premiums
        • Non-Medicare plan premiums
        • Life insurance premiums
        • Long term disability insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • For newly eligible members
        • Verify & enroll my dependents
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify PEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
      • Get help
        • Contact the plans
        • Help with PEBB My Account
        • About Benefits 24/7
        • Accessing SmartHealth
    • SEBB Continuation Coverage
      • Find benefits
        • Medical plans & benefits
        • Dental plans & benefits
        • Vision plans & benefits
        • Benefits while traveling
        • Find a SEBB plan provider
        • Life & FSA benefits
        • SEBB wellness programs
      • Explore costs
        • Medical, dental & vision plan premiums
        • Life insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • For newly eligible members
        • Verify & enroll my dependents
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify SEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
      • Get help
        • Contact the plans
        • Help with SEBB My Account
        • About Benefits 24/7
        • Accessing SmartHealth
      Quick links
      • Find forms & publications
      • Retiree engagement
      • Preparing for retirement?
      • Public employees
      • Log into PEBB My Account
      • PEBB newsletters
      • Visit our PEBB Virtual Benefits Fair
      • File a PEBB appeal
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        • Denied coverage? You may still be eligible.
      • Learn how to enroll
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      • For survivors
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        • Enroll as a survivor
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        • Am I eligible?
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      • Learn how to enroll
        • For newly eligible members
        • Verify & enroll my dependents
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        • Enroll as a survivor
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      • Manage benefits
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      Quick links
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      • Learn how to enroll
        • For newly eligible members
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  • Billers, providers & partners
    • Prior authorization, claims & billing
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        • For new providers
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      • Submit prior authorization (PA)
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      Quick links
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        • Audit & program integrity
      • Submit prior authorization (PA)
        • Step-by-step guide for prior authorization (PA)
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    • Program information for providers
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      • Programs: A-E
        • 340B Drug Pricing Program
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        • Child & youth behavioral health services
        • Community behavioral support services
        • Dental services
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        • Durable medical equipment
        • Early, Periodic Screening, Diagnosis, and Treatment
        • 340B Drug Pricing Program
        • 90- & 180-day civil commitment beds
        • Applied Behavior Analysis therapy
        • Child & youth behavioral health services
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      • Programs: F-H
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        • Family Planning Only
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        • Health Home
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      • Programs: I-N
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        • Managed care
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        • Immunization services
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        • Intensive behavioral health treatment facilities
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        • Kidney Disease Program
        • Managed care
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      • Programs: O-P
        • Partnership Access Lines
        • Peer support
        • Pharmacy services
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        • Prescription drug discount card
        • Program of Assertive Community Treatment
        • Partnership Access Lines
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        • Program of Assertive Community Treatment
      • Programs: Q-Z
        • Resources for behavioral health providers
        • School-based health care services
        • Substance use disorder
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        • Transhealth program
        • Transportation services (nonemergency)
        • Resources for behavioral health providers
        • School-based health care services
        • Substance use disorder
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        • Transhealth program
        • Transportation services (nonemergency)
      Quick links
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      • News
      • Getting started
        • Program benefit packages & scope of services
        • Patient review & coordination
        • Program benefit packages & scope of services
        • Patient review & coordination
      • Programs: A-E
        • 340B Drug Pricing Program
        • 90- & 180-day civil commitment beds
        • Applied Behavior Analysis therapy
        • Child & youth behavioral health services
        • Community behavioral support services
        • Dental services
        • Designated crisis responders
        • Durable medical equipment
        • Early, Periodic Screening, Diagnosis, and Treatment
        • 340B Drug Pricing Program
        • 90- & 180-day civil commitment beds
        • Applied Behavior Analysis therapy
        • Child & youth behavioral health services
        • Community behavioral support services
        • Dental services
        • Designated crisis responders
        • Durable medical equipment
        • Early, Periodic Screening, Diagnosis, and Treatment
      • Programs: F-H
        • Family Planning Only
        • First Steps (maternity support & infant care)
        • Foster care & adoption support
        • Ground emergency medical transportation
        • Health Home
        • Home health care services: electronic visit verification
        • Family Planning Only
        • First Steps (maternity support & infant care)
        • Foster care & adoption support
        • Ground emergency medical transportation
        • Health Home
        • Home health care services: electronic visit verification
      • Programs: I-N
        • Immunization services
        • Indian health programs
        • Intensive behavioral health treatment facilities
        • Intensive residential treatment teams
        • Interpreter services
        • Kidney Disease Program
        • Managed care
        • Medicaid Administrative Claiming
        • Immunization services
        • Indian health programs
        • Intensive behavioral health treatment facilities
        • Intensive residential treatment teams
        • Interpreter services
        • Kidney Disease Program
        • Managed care
        • Medicaid Administrative Claiming
      • Programs: O-P
        • Partnership Access Lines
        • Peer support
        • Pharmacy services
        • Preadmission screening and resident review
        • Prescription drug discount card
        • Program of Assertive Community Treatment
        • Partnership Access Lines
        • Peer support
        • Pharmacy services
        • Preadmission screening and resident review
        • Prescription drug discount card
        • Program of Assertive Community Treatment
      • Programs: Q-Z
        • Resources for behavioral health providers
        • School-based health care services
        • Substance use disorder
        • Suicide prevention resources
        • Transhealth program
        • Transportation services (nonemergency)
        • Resources for behavioral health providers
        • School-based health care services
        • Substance use disorder
        • Suicide prevention resources
        • Transhealth program
        • Transportation services (nonemergency)
    • Become an Apple Health provider
      • Learn how to enroll
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      • What's next
        • Track my application
        • Find next steps for new Medicaid providers
        • Track my application
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      • For existing medicaid providers
        • Update my provider information
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        • Revalidation
      Quick links
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      • Learn how to enroll
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        • Enroll as a nonbilling provider
        • Enroll as a billing agent or clearinghouse
        • Enrollment overview
        • Eligible provider types & requirements
        • Become a behavioral health provider
        • Enroll as a billing provider
        • Enroll as a health care professional practicing under a group or facility
        • Enroll as a nonbilling provider
        • Enroll as a billing agent or clearinghouse
      • What's next
        • Track my application
        • Find next steps for new Medicaid providers
        • Track my application
        • Find next steps for new Medicaid providers
      • For existing medicaid providers
        • Update my provider information
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    • Learn ProviderOne
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        • Fact sheets
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    • Prior authorization, claims & billing
      • Getting started
        • For new providers
        • Overview of prior authorization (PA), claims & billing
        • Document submission cover sheets
        • HIPAA Electronic Data Interchange (EDI)
        • Request a Zoom license
        • Audit & program integrity
        • For new providers
        • Overview of prior authorization (PA), claims & billing
        • Document submission cover sheets
        • HIPAA Electronic Data Interchange (EDI)
        • Request a Zoom license
        • Audit & program integrity
      • Submit prior authorization (PA)
        • Step-by-step guide for prior authorization (PA)
        • Pharmacy prior authorization
        • Step-by-step guide for prior authorization (PA)
        • Pharmacy prior authorization
      • Submit claims
        • Provider billing guides & fee schedules
        • Hospital rates & reimbursement
        • Provider billing guides & fee schedules
        • Hospital rates & reimbursement
      Quick links
      • Log into ProviderOne
      • Find billing guides & fee schedules
      • Find forms & publications
      • Sign up for Provider Alerts
      • ProviderOne Billing & Resource Guide
      • ProviderOne Discovery Log
      • ProviderOne maintenance
      • Termination & exclusion list
      MM - Footer
      • Contact us
      • News
      • Getting started
        • For new providers
        • Overview of prior authorization (PA), claims & billing
        • Document submission cover sheets
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        • Request a Zoom license
        • Audit & program integrity
        • For new providers
        • Overview of prior authorization (PA), claims & billing
        • Document submission cover sheets
        • HIPAA Electronic Data Interchange (EDI)
        • Request a Zoom license
        • Audit & program integrity
      • Submit prior authorization (PA)
        • Step-by-step guide for prior authorization (PA)
        • Pharmacy prior authorization
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  1. Home
  2. About HCA
  3. Programs & initiatives
  4. Public Employees Benefits Board (PEBB) Program
  5. PEBB rules and policies

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PEBB rules and policies

The PEBB Program follows the rules in Washington Administrative Code (WAC). Our administrative policies describe how we implement a law or rule affecting participation in PEBB benefits.

On this page

  • PEBB Program law
  • PEBB Program rules
  • PEBB Program policies
  • Proposed policies
  • Rescinded or superseded policies
  • PEBB Program salary reduction plan
  • PEBB wellness plan

Stay up-to-date with PEBB Program rule making and policy activity

Sign up for notices

PEBB Program law

You can find the PEBB Program's existing law in chapter 41.05 of the Revised Code of Washington (RCW).

PEBB Program rules

The PEBB Program follows the rules in Washington Administrative Code (WAC) chapters:

  • 182-08
  • 182-12
  • 182-16

Below are links to the detailed rules for circumstances most common to employees, retirees, and dependents:

  • Eligible and ineligible employees
  • When are retiring employees eligible to enroll in retiree insurance?
  • Who are eligible dependents?
  • When must newly eligible employees select PEBB benefits and complete enrollment forms?
  • Is dual enrollment in PEBB and SEBB prohibited?
  • When may an employee waive enrollment in PEBB medical and when they enroll in PEBB medical after having waived enrollment?
  • May a retiree or a survivor defer enrollment or voluntarily terminate enrollment under PEBB retiree insurance coverage?
  • When may subscribers enroll or remove eligible dependents?
  • When may subscribers change health plans?
  • PEBB appeals rules

To find a specific WAC section look under chapters 182-08, 182-12, or 182-16.

PEBB Program policies

The PEBB Program's administrative policies describe how we implement a law or rule affecting participation in PEBB benefits. The statements made in these documents reflect our interpretations of the eligibility and enrollment rules.

Employee eligibility and enrollment

Number Title Effective date
11-1

Providing a notice to an employee and a state agency

1/1/2023

1/1/2024

11-3

Correcting employing agency and contracted vendor enrollment errors

1/1/2023

15-1 Determining eligibility for a seasonal employee and maintenance of employer contribution through the off-season

1/1/2023

17-1 Determining faculty eligibility for summer/short class sessions

1/1/2023

17-2 Determining faculty eligibility after a layoff

1/1/2023

1/1/2024

17-3 Determining faculty eligibility for off-quarter/semester or for decreases in workload

1/1/2023

19-1 Termination due to loss of eligibility or enrollment error

1/1/2023

1/1/2024

19-1A Addendum - Termination due to loss of eligibility or enrollment error: Employee

1/1/2023

1/1/2024

19-1B Addendum - Termination due to loss of eligibility or nonpayment: Self-pay subscriber

1/1/2023

1/1/2024

Retiree eligibility and enrollment

Number Title Effective date
21-1 Exemption from the retiree deferral form requirement

1/1/2023

1/1/2024

26-1 Administering PEBB retiree medical plan enrollment in coordination with Medicare Part D

1/1/2023

1/1/2024

Dependent eligibility and enrollment

Number Title Effective date
31-1 Verifying dependent eligibility before enrollment

1/1/2023

1/1/2024

31-2 Use of the PEBB Spousal Plan Calculator

1/1/2023

1/1/2024

33-1 Verifying legal union's residency status

1/1/2023

36-1 Certifying eligibility for a dependent child with a disability who is age 26 or older

1/1/2023

1/1/2024

37-1 Certifying eligibility for an extended dependent child

1/1/2023

Special open enrollment

Number Title Effective date
45-2 Special Open Enrollment (SOE)

1/1/2023

1/1/2024

45-2A Addendum - Special open enrollment (SOE) matrix: Summary of permitted election changes

1/1/2023

1/1/2024

Reinstatement, tolling, and continuation coverage

Number

Title Effective date

56-1

Continuation coverage and retiree insurance coverage reinstatement for subscribers with mental or physical impairment or incapacitation

1/1/2023

1/1/2024

56-2 Election period tolling for applicants with mental impairment or physical incapacitation

1/1/2023

1/1/2024

Appeals

Number

Title Effective date
60-1 Required appeals related documents when the PEBB Program conducts a brief adjudicative proceeding

1/1/2023

Administrative - permanent

Number Title Effective date
90-1 Allowable mid-year employer group terminations for an employer group or board members of school districts and educational service districts

1/1/2023

1/1/2024

90-2

What authority do employer groups or board of directors for school districts and educational service districts need before contracting with the Health Care Authority (HCA) for participation in Public Employees Benefits Board (PEBB) for insurance coverage?

1/1/2023

1/1/2024

90-3

Determining if an employer group or board of directors for school districts and educational service districts requesting eligibility criteria different from Public Employees Benefits Board (PEBB) Program rules shall be approved

1/1/2023

1/1/2024

91-1 Requesting a reasonable alternative for completing wellness incentive program requirements or avoiding the tobacco use premium surcharge

1/1/2023

1/1/2024

91-2 Tobacco as it relates to religious or ceremonial use

1/1/2023

1/1/2024

91-3 Washington Wellness worksite designation program incentive requirements

1/1/2023

1/1/2024

93-2

PEBB Program payment plans for continuation coverage and retiree accounts

1/1/2023

94-1 Accessing PEBB Program salary reduction plan document

1/1/2023

1/1/2024

94-2 Accessing PEBB Program wellness plan document

1/1/2023

1/1/2024

94-3 Subscriber mistake - Factor test

1/1/2023

1/1/2024

Proposed policies

There are currently no proposed policies.

Rescinded or superseded policies

The policies listed below are rescinded. If you have any questions, please contact the PEBB Policy and Rules team at the address at the bottom of this page.

Number Title Policy effective date
11-1

Providing notifications to employees and employers

1/1/2021
1/1/2020
1/1/2019
1/1/2018
6/1/2010

11-3

Correcting employing agency enrollment errors

1/1/2022
1/1/2021
1/1/2020
1/1/2019
1/1/2018
1/1/2017
1/1/2016
1/1/2015
1/1/2014

15-1 Determining eligibility for seasonal employees and maintenance of employer contribution through the off-season

1/1/2020
1/1/2019
1/1/2018
1/1/2017
1/1/2016
1/1/2015
1/1/2011

17-1 Determining faculty eligibility for summer/short class sessions

1/1/2022
1/1/2020
1/1/2018
1/1/2017
1/1/2010

17-2 Determining faculty eligibility after a layoff

1/1/2021
1/1/2019
1/1/2018
1/1/2017
1/1/2014
1/1/2010

17-3 Determining faculty eligibility for off-quarter/semester or for decreases in workload

1/1/2022
1/1/2021
1/1/2019
1/1/2018
1/1/2017
1/1/2014

19-1 Termination due to loss of eligibility

1/1/2022
1/1/2021
1/1/2020
1/1/2019
1/1/2018
1/1/2017
1/1/2016
1/1/2015
1/1/2014
1/1/2013
1/1/2012

19-1A Addendum - Termination due to loss of eligibility: Employee

1/1/2022
1/1/2021
1/1/2020
1/1/2019
1/1/2018
1/1/2017
1/1/2016
1/1/2015
1/1/2014
1/1/2013
1/1/2012

19-1B Addendum - Termination due to loss of eligibility: Self-pay subscriber

1/1/2022
1/1/2021
1/1/2020
1/1/2019
1/1/2018
1/1/2017
1/1/2016
1/1/2015
1/1/2014
1/1/2013
1/1/2012

21-1 Exemption from retiree deferral form

1/1/2022
1/1/2021
1/1/2020
1/1/2019
1/1/2018
1/1/2017
1/1/2016
1/1/2015
1/1/2014
1/1/2013

26-1 Administering PEBB insurance in coordination with Medicare Part D

1/1/2022
1/1/2021
4/1/2020
1/1/2019
1/1/2018
1/1/2017
1/1/2015
1/1/2013
1/1/2012

31-1 Verifying dependent eligibility before enrollment

1/1/2022
1/1/2021
1/1/2020​
1/1/2019

1/1/2018
1/1/2017
1/1/2016
1/1/2015
1/1/2014
1/1/2013

31-2

Use of premium surcharge help sheet and spousal plan questionnaire and calculator tools

1/1/2022
1/1/2020
1/1/2019
1/1/2018
1/1/2016
1/1/2015
4/26/2014

33-1 Verifying Legal Union's Residency Status 1/1/2021
1/1/2020
1/1/2019
1/1/2018
4/26/2014
36-1 Certifying eligibility for a dependent child with a disability who is age 26 or older

1/1/2021
1/1/2020
1/1/2019
11/29/2018
1/12/2018
1/1/2015
1/1/2014
1/1/2012

37-1 Certifying eligibility for an extended dependent child

1/1/2022
1/1/2021
1/1/2020
1/1/2019
1/1/2018
1/1/2016
1/1/2014
1/1/2013
12/12/2011

45-2 Special Open Enrollment (SOE)

1/1/2022
1/1/2021
1/1/2020
1/1/2019
1/1/2018
1/1/2017
1/1/2016
1/1/2015
4/26/2014
1/1/2014
1/1/2013
1/1/2012

45-2A Addendum - Special open enrollment (SOE) matrix: Summary of permitted election changes

1/1/2022
1/1/2021
1/1/2020
1/1/2019
1/1/2018
1/1/2017
1/1/2016
1/1/2015
4/26/2014
1/1/2014
1/1/2013
1/1/2012

56-1

Continuation Coverage and retiree insurance coverage reinstatement for subscribers with mental impairment or physical incapacitation

1/1/2022
1/1/2021
1/1/2020
1/1/2019
1/1/2018
56-2

Continuation Coverage and retiree insurance coverage election period tolling for applicants with mental impairment or physical incapacitation

1/1/2022
1/1/2021
1/1/2020
1/1/2018
60-1 Required appeals related documents when the PEBB Program is hearing an appeal 1/1/2020
1/1/2019
1/1/2018
90-1 Allowable mid-year employer group terminations

1/1/2021
1/1/2020
1/1/2018
1/1/2017
1/1/2014

90-2 What authority to employer groups or charter schools need before contracting with the Health Care Authority (HCA) for participation in Public Employees Benefits Board (PEBB) for insurance coverage? 1/1/2021
1/1/2020
1/1/2018
90-3 Determining if an employer group or charter school requesting eligibility standards different from Public Employees Benefits Board (PEBB) program rules shall be approved 1/1/2021
1/1/2020
1/1/2018
91-1 Requesting a reasonable alternative for completing wellness incentive program requirements or avoiding the tobacco use premium surcharge

1/1/2022
1/1/2021
1/1/2020
1/1/2019
1/1/2018
1/1/2017
1/1/2016
1/1/2015
7/1/2014
4/26/2014

91-2 Tobacco as it relates to religious or ceremonial use 1/1/2022
1/1/2020
1/1/2018
4/26/2014
91-3 Washington Wellness worksite designation program incentive requirements 1/1/2022
1/1/2021
1/1/2020
1/1/2019
1/1/2018
93-2 PEBB Program payment plans 1/1/2021
1/1/2020
1/1/2018
94-1 Accessing PEBB Program salary reduction plan document 1/1/2020
94-2 Accessing PEBB Program wellness plan document 1/1/2020

PEBB Program salary reduction plan

  • PEBB Program salary reduction plan

PEBB wellness plan

  • 2023 wellness plan

Contact

Mail:

Washington State Health Care Authority
PEBB Policy, Rules, and Compliance
PO Box 42684
Olympia, WA 98504-2684

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