Meetings and materials

Effective January 1, 2022, the Uniform Medical Plan (UMP) benefit design, for all Medicare and non-Medicare plans, of the Chiropractic, Acupuncture, and Massage (CAM) benefits included in prior Board policy decisions and resolutions is rescinded and replaced with the following CAM benefit design:

Treatment limitations will be as follows:

• Chiropractic visits are limited to 24 per plan year;
• Acupuncture visits are limited to 24 per plan year;
• Massage visits are limited to 24 per plan year;

Cost sharing for all UMP plans will be as follows:

• In network services will have a copay and neither the services nor the copay will apply toward the deductibles (except for UMP Consumer Directed Health Plan (CDHP) as described below), but the copay will apply toward the annual out of pocket maximums;

Out of network services will not have copays and will have:

• a 40% member coinsurance of the allowed amount for all UMP plans except UMP Plus, which will be a 50% member coinsurance, applies after the deductible is met and the coinsurance applies to the annual out of pocket maximum;
• no charges above the allowed amount apply toward UMP plan deductibles or the annual out of pocket maximum; and
• coverage only for Chiropractic and Acupuncture services,

UMP CDHP members need to meet their deductible before the plan will pay any portion of the allowed amount for any claim, for both in network and out of network services; and

Medicare claims will be processed in accordance with coordination of benefits rules.

This benefit design applies only if approved by both the PEB Board and SEB Board.

The benefit design of the employer-paid (or basic) long-term disability benefit included in prior Board policy decisions and resolutions is rescinded and replaced with the following employer-paid LTD benefit design:

• The following Benefit Waiting Period (the longer of):
  • 90 days;
  • The entire period of sick leave (excluding shared leave) for which the employee is eligible;
  • The Fractionated Period of Paid Time Off (PTO) for which the employee is eligible, if your employer has a PTO plan, as those terms are defined in the policy;
  • The entire period of other non-vacation salaried continuation leave for which the employee is eligible; or
  • The end of Washington Paid Family and Medical Leave for which the employee is receiving benefits
• No Choice Sick Leave
• Choice Pension
• Maximum Monthly Benefit $240 (60% of $400)

Amending PEBB 2020-04 to read: 

the default election for an eligible employee who fails to timely elect coverage will now be as follows:

• Enrollment in employee-only medical coverage;
• Enrollment in employee-only dental coverage;
• Enrollment in basic life insurance;
• Enrollment in employer-paid long-term disability insurance; and
• Enrollment in employee-paid long-term disability insurance at the 60% coverage level.

• All employees who are eligible for the employer contribution towards PEBB benefits as of December 31, 2021 and not already enrolled in supplemental LTD insurance or did not make an election (reducing or declining coverage) during an enrollment period established by the Health Care Authority in 2021, will be auto-enrolled in employee-paid LTD insurance at the 60% coverage level with an effective date of January 1, 2022 without Evidence of Insurability (EOI).
• An employee who becomes eligible for the employer contribution towards PEBB benefits on or after January 1, 2022 must make an election (reducing or declining coverage) during the benefit election period. If the employee fails to timely elect coverage, the employee will be defaulted into coverage according to Resolution PEBB 2021-12 without EOI. The effective date of coverage will be according to the policy established in May 1995.
• After January 1, 2022, an employee at any time may elect to reduce employee-paid LTD to the 50% coverage plan without EOI or fully decline employee-paid LTD. The effective date of the change in coverage will be the first day of the month following the date the employer receives the required election.
• An employee who seeks to increase coverage from the 50% coverage plan to the 60% coverage plan, or access previously declined employee-paid LTD, will be subject to evidence of insurability. The effective date of the change in coverage will be the day of the month the contracted vendor approves the required form.
• Any employee who declines employee-paid LTD insurance will remain enrolled in employer-paid LTD insurance.

the benefit design of the supplemental (or optional) long-term disability benefit included in prior Board policy decisions and resolutions is rescinded and replaced with the following employee-paid LTD benefit design:

Two separate employee-paid LTD insurance choices including: (a) coverage at 60% or (b) coverage at 50%. Both choices will have the following features:

• The following Benefit Waiting Period (the longer of):
  • 90 days;
  • The entire period of sick leave (excluding shared leave) for which the employee is eligible;
  • The Fractionated Period of Paid Time Off (PTO) for which the employee is eligible, if your Employer has a PTO plan, as those terms are defined in the policy;
  • The entire period of other non-vacation salaried continuation leave for which the employee is eligible; or
  •  The end of Washington Paid Family and Medical Leave Law for which the employee is receiving benefits
• No Choice Sick Leave
• Choice Pension
• A Maximum Monthly Benefit of $10,000 for the 60% coverage and $8,333 for the 50% coverage

Enrollment requirements when an employee loses dependent coverage in SEBB benefits

If an employee who is eligible for the employer contribution towards PEBB benefits was enrolled as a dependent in SEBB benefits and is dropped by the SEBB subscriber, HCA will notify the employee of their removal from the SEBB subscriber’s account and that they have experienced a special enrollment event. The employee will be required to return from waive status and elect PEBB medical and PEBB dental. If the employee’s employing agency does not receive the school employee's required forms indicating their medical and dental elections within sixty days of the employee losing SEBB benefits, they will be defaulted into employee-only PEBB medical and PEBB dental.

4/14/21

PEBB benefit automatic enrollments when SEBB benefits are auto-disenrolled

If an employee’s dependent, who is also a school employee who was auto-disenrolled from their SEBB dental and SEBB vision as a result of SEBB Board Resolution 2021- 04, the employee’s dependent will be automatically enrolled in the employee’s dental plan if they are not already enrolled.

If an employee’s dependent is enrolled in both PEBB medical and SEBB medical as a dependent and has been enrolled in SEBB benefits longer than they have been enrolled in PEBB benefits, but no action is taken to resolve the dual enrollment, the dependent will remain in SEBB benefits and will be auto-disenrolled from the employee’s PEBB medical and/or dental plans if they are enrolled.

If an employee’s dependent is not enrolled in any medical but is enrolled only in PEBB dental and SEBB vision (with or without SEBB dental) as a dependent, the dependent will be kept in SEBB benefits and auto-disenrolled from PEBB dental.

Exception: If there is a National Medical Support Order or a court order in place, enrollment will be in accordance with the order.

Removing the retiree two-year dental enrollment requirement