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 Program benefits.

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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:

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

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 Program 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 an employer

1/1/2019

11-3

Correcting employing agency and contracted vendor enrollment errors

1/1/2019
15-1 Determining eligibility for a seasonal employee and maintenance of employer contribution through the off-season 1/1/2019
17-1 Determining faculty eligibility for summer/short class sessions 1/1/2018
17-2 Determining faculty eligibility after a layoff 1/1/2019
17-3 Determining faculty eligibility for off-quarter/semester or for decreases in workload 1/1/2019
19-1 Termination due to loss of eligibility 1/1/2019
19-1A Addendum - Termination due to loss of eligibility: Employee 1/1/2019
19-1B Addendum - Termination due to loss of eligibility: Self-pay subscriber 1/1/2019

Retiree eligibility and enrollment

Number Title Effective Date
21-1 Exemption from the retiree deferral form requirement 1/1/2019
26-1 Administering PEBB insurance in coordination with Medicare Part D 1/1/2019

Dependent eligibility and enrollment

Number Title Effective Date
31-1 Verifying dependent eligibility before enrollment 1/1/2019
31-2 Use of premium surcharge help sheet and spousal plan calculator tools 1/1/2019
33-1 Verifying legal union's residency status 1/1/2019
36-1 Certifying eligibility for a dependent child with a disability who is age 26 or older 1/1/2019
37-1 Certifying eligibility for an extended dependent child 1/1/2019

Special open enrollment

Number Title Effective Date
45-2 Special Open Enrollment (SOE) 1/1/2019
45-2A Addendum - Special open enrollment (SOE) matrix: Summary of permitted election changes 1/1/2019

Continuation Coverage

Number

Title Effective Date

56-1

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

1/1/2019

56-2 Election period tolling for applicants with mental impairment or physical incapacitation 1/1/2019

Appeals

Number

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

1/1/2019

Administrative - Permanent

Number Title Effective Date
90-1 Allowable mid-year employer group terminations 1/1/2018
90-2 What authority do 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? 1/1/2018
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 1/1/2018
91-1 Requesting a reasonable alternative for completing wellness incentive program requirements or avoiding the tobacco use premium surcharge 1/1/2019
91-2 Tobacco as it relates to religious or ceremonial 1/1/2018
91-3 Washington Wellness worksite designation program incentive requirements 1/1/2019

Proposed policies

Below are the proposed policies.

Number

Title

Effective date

11-1

Providing a notice to an employee and an employer

1/1/2020

11-3

Correcting employing agency and contracted vendor enrollment errors 1/1/2020
15-1

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

1/1/2020
17-1

Determining faculty eligibility for summer/short class sessions

1/1/2020
19-1

Termination due to loss of eligibility or enrollment error

1/1/2020
19-1A Addendum - Termination due to loss of eligibility or enrollment error: Employee 1/1/2020
19-1B Addendum - Termination due to loss of eligibility or nonpayment: Self-pay subscriber 1/1/2020
21-1 Exemption from the retiree deferral form requirement 1/1/2020
31-1 Verifying dependent eligibility before enrollment 1/1/2020
31-2 Use of PEBB premium surcharge attestation help sheet and spousal plan calculator tools 1/1/2020
33-1 Verifying legal union's residency status 1/1/2020
36-1 Certifying eligibility for a dependent child with a disability who is age 26 or older 1/1/2020
37-1 Certifying eligibility for an extended dependent child 1/1/2020
45-2 Special Open Enrollment (SOE) 1/1/2020
45-2A Addendum - SOE matrix 1/1/2020
56-1 Continuation Coverage and retiree insurance coverage reinstatement for subscribers with mental or physical impairment or incapacitation 1/1/2020
56-2 Election period tolling for applicants with mental or physical impairment or incapacitation 1/1/2020
60-1 Required appeals related documents when the PEBB Program conducts a brief adjudicative proceeding 1/1/2020
90-1 Allowable mid-year employer group terminations 1/1/2020
90-2 What authority do employer groups need before contracting with the Health Care Authority for participating in PEBB for insurance coverage? 1/1/2020
90-3 Determining if an employer group requesting eligibility standards different from PEBB Program rules shall be approved 1/1/2020
91-1 Requesting a reasonable alternative for completing wellness incentive program requirements or avoiding the tobacco use premium surcharge 1/1/2020
91-2 Tobacco as it relates to religious or ceremonial use 1/1/2020
91-3 Washington wellness worksite designation program incentive requirements 1/1/2020
93-2 PEBB Program payment plans 1/1/2020
94-1 Accessing PEBB Program salary reduction plan document 1/1/2020
94-2 Accessing PEBB Program wellness plan document 1/1/2020

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

1/1/2018
6/1/2010

11-3

Correcting employing agency enrollment errors

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

1/1/2018
1/1/2017
1/1/2016
1/1/2015
1/1/2011

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

1/1/2017
1/1/2010

17-2 Determining faculty eligibility after a layoff

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

1/1/2018
1/1/2017
1/1/2014

19-1 Termination due to loss of eligibility

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

1/1/2018
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

1/1/2018
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

1/1/2018
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

1/1/2018
1/1/2017
1/1/2015
1/1/2013
1/1/2012

31-1 Verifying dependent eligibility before enrollment

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

1/1/2018
1/1/2016
1/1/2015
4/26/2014

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

11/29/2018
1/12/2018
1/1/2015
1/1/2014
1/1/2012

37-1 Certifying eligibility for an extended dependent child

1/1/2018
1/1/2016
1/1/2014
1/1/2013
12/12/2011

45-2 Special Open Enrollment (SOE)

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

1/1/2018
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

1/1/2018
56-2

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

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

1/1/2017
1/1/2014

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

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 4/26/2014
91-3 Washington Wellness worksite designation program incentive requirements 1/1/2018

PEBB Program salary reduction plan

PEBB Program wellness plan

Contact

Mail:

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