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How to determine eligibility

Find out if you're eligible for COBRA or Continuation Coverage (LWOP) benefits.

What is COBRA continuation coverage?

Federal law requires that most group health plans (including the Public Employees Benefits Board [PEBB] Program) give employees and their families the opportunity to continue their health coverage when they lose coverage under an employer’s plan.

Continuation Coverage provides the same medical and dental benefits, choice of health plans, and cost-sharing (including annual deductibles, copays, and coinsurance) available to other PEBB enrollees who aren’t enrolled in Continuation Coverage.

Each person who elects Continuation Coverage has the same rights as other PEBB enrollees, including annual open enrollment and special open enrollment rights.

COBRA and other continuation coverage options offer you and your covered dependents the opportunity to enroll in the same medical and dental plans you had at the time you lost eligibility, but only temporarily and with no employer contribution. You must meet procedural requirements and pay the premium (and any applicable surcharges) each month from the date you lose PEBB health plan coverage.

What continuation coverage options are available?

The PEBB Program offers several ways for eligible members to continue PEBB Program health plan coverage.

  1. Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage
    A temporary extension of PEBB health plan coverage available to PEBB members defined as qualified beneficiaries under federal rules. Each qualified beneficiary may choose COBRA. Those choosing COBRA coverage must pay the premium. The type of qualifying event determines how long you may continue COBRA coverage.
  2. PEBB Continuation Coverage
    A temporary extension of PEBB health plan coverage as an alternative for PEBB members who are not qualified beneficiaries under COBRA coverage and for those individuals in specific situations (Leave Without Pay [LWOP] coverage). Monthly premiums are the same as for COBRA. Life and long-term disability (LTD) insurance have separate premiums you must pay if you choose to continue under LWOP.
  3. PEBB retiree insurance coverage
    A continuation of PEBB health plan coverage available to employees and survivors who meet retiree eligibility and enrollment requirements. See Retiree eligibility and enrollment.

When is continuation coverage available?

The PEBB Program will offer continuation coverage to you or your covered dependents after you, your survivors, a representative acting on your behalf, or your employer notifies the PEBB Program that you or your dependents are no longer eligible for benefits.

When a qualifying event occurs and the PEBB Program is properly notified, we will send a PEBB Continuation Coverage Election Notice booklet that provides information on how to continue PEBB health plan coverage.

Who can elect continuation coverage?

Once the PEBB Program receives notice that a qualifying event has occurred, it will offer continuation coverage to each qualified beneficiary. Each covered dependent who loses PEBB health plan coverage will have an independent right to elect COBRA or PEBB Continuation Coverage. Dependents do not have independent election rights to PEBB Continuation Coverage (Leave Without Pay) and can only be enrolled if the employee enrolls.

Employees may elect continuation coverage on behalf of their spouses or state-registered domestic partners, and parents may elect continuation coverage on behalf of their children.

Any qualified beneficiary for whom continuation coverage is not elected within the 60-day period specified in the PEBB Continuation Coverage Election Notice will lose his or her right to elect continuation coverage.

What is COBRA?

COBRA coverage is a continuation of health plan coverage when it would otherwise end because of a qualifying event. After a qualifying event occurs, the PEBB Program is required to offer COBRA to each person who is a qualified beneficiary.

Who is entitled to COBRA?

You, your spouse (or former spouse), and your dependent children who lost PEBB health plan coverage due to a qualifying event listed below are qualified beneficiaries, and are entitled to independent election rights under COBRA.

You may choose to continue coverage you are enrolled in on the day before the qualifying event occurs (medical coverage only, dental coverage only, or both medical and dental coverage) by self-paying the premiums. Unless your eligible dependents make independent elections, they will be enrolled in the same plans you elect. If enrolled in a Medical Flexible Spending Arrangement (FSA), you can choose to continue it until the end of the plan year in which the qualifying event occurs.

Qualifying events for COBRA coverage

Employee

  • Your hours of employment are reduced below the number of hours required to be eligible for the employer contribution toward health care coverage.
  • Your employment ends for any reason other than gross misconduct.

Retiree

  • Your employer group ends participation in PEBB health coverage. (Retirees of school districts and educational service districts can continue their PEBB retiree coverage, even if their district discontinues participation or never participated with the PEBB Program.)
  • The Department of Retirement Systems (DRS) determines you are no longer disabled, so your pension stops.

Spouse

  • Your spouse (the employee or retiree) dies, and you don’t qualify for PEBB retiree insurance coverage as a surviving spouse.
  • Your spouse’s (the employee’s) hours of employment are reduced.
  • Your spouse’s (the employee’s) employment ends for any reason other than for gross misconduct.
  • You divorce. If your spouse (the employee or retiree) reduces or cancels your PEBB health plan coverage in anticipation of a divorce, the divorce may be considered a qualifying event even though you lost coverage before the divorce was final.

Dependent children

  • Your parent (the employee or retiree) dies, and you don’t qualify for PEBB retiree insurance coverage as a surviving dependent.
  • Your parent (the employee’s) hours of employment are reduced.
  • Your parent (the employee’s) employment ends for any reason other than gross misconduct.
  • Your eligibility for PEBB coverage as a dependent child ends.

Children born to or placed for adoption with the covered employee during the COBRA coverage period

A child born to, adopted by, or placed for adoption with a covered employee during a period of COBRA coverage is considered a qualified beneficiary. The child’s COBRA coverage begins when the child is enrolled in PEBB coverage, whether through a special open enrollment or annual open enrollment, and lasts for the duration of the COBRA coverage period, measured from the original qualifying event date. To be enrolled in PEBB health coverage, the child must otherwise satisfy PEBB eligibility requirements.

Alternate recipients under National Medical Support Notice (NMSN) or court order

A child of the covered employee who is receiving benefits pursuant to a NMSN or court order, received by the employer or the PEBB during the covered employee’s period of employment, is entitled to the same rights to COBRA coverage as an eligible dependent child of the covered employee.

Who is entitled to PEBB Continuation Coverage?

Your state-registered domestic partner (or former domestic partner) and their children who lost PEBB health plan coverage due to the events below are entitled to independent election rights under Continuation Coverage. They may continue the same benefits available to COBRA members.

Qualifying events for PEBB Continuation Coverage

State-registered domestic partner

  • Your state-registered domestic partner (the employee or retiree) dies, and you do not qualify for PEBB retiree insurance coverage as a surviving state-registered domestic partner.
  • Your state-registered domestic partner (the employee’s) hours of employment are reduced.
  • Your state-registered domestic partner (the employee’s) employment ends for any reason other than gross misconduct.
  • Your state-registered domestic partnership is terminated. If your state-registered domestic partner (the employee or retiree) reduces or cancels your PEBB health plan coverage in anticipation of the domestic partnership’s termination, the domestic partnership termination may be considered a qualifying event even though you lost coverage before the legal termination of the state-registered domestic partnership was final.

State-registered domestic partner's children

  • Your parent’s state-registered domestic partner (the employee or retiree) dies, and you don’t qualify for PEBB retiree insurance coverage as a surviving dependent.
  • Your parent’s state-registered domestic partner (the employee’s) hours of employment are reduced.
  • Your parent’s state-registered domestic partner (the employee’s) employment ends for any reason other than gross misconduct.
  • Your eligibility for PEBB coverage as a dependent child ends.

Who is entitled to PEBB Continuation Coverage (Leave Without Pay [LWOP])?

As an employee who lost PEBB insurance coverage due to one of the events listed below, you are entitled to PEBB Continuation Coverage (LWOP). Employees may continue medical and dental benefits, Medical Flexible Spending Arrangement (FSA), life insurance, and in some cases, long-term disability insurance. You must enroll in PEBB Continuation Coverage (LWOP) to enroll your eligible dependents. Your eligible dependents do not have independent election rights.

Qualifying events for PEBB Continuation Coverage (LWOP)

Employee

  • You are on authorized leave without pay from your agency.
  • You are on approved educational leave.*
  • You are receiving time-loss benefits under workers' compensation.
  • You are called to active duty in the uniformed services, as defined under the Uniformed Services Employment and Reemployment Rights Act (USERRA).*
  • Your employment ends due to a layoff.
  • You are applying for disability retirement.
  • You are reverting (for reasons other than a layoff) to a position that is not eligible for the employer contribution toward insurance coverage.
  • You are a faculty member who is between periods of eligibility.
  • You are a seasonal employee who is between periods of eligibility.
  • You are appealing a dismissal action.

* You may also be entitled to continue long-term disability insurance.

What is a qualified beneficiary?

A qualified beneficiary is an employee, spouse, or dependent child who lost PEBB health coverage due to a qualifying event and may choose COBRA coverage. State-registered domestic partners and their children who lost PEBB health coverage due to the same types of events may choose PEBB Continuation Coverage, which is an alternative created for PEBB members who are not qualified beneficiaries under COBRA. When the PEBB Program uses the term "qualified beneficiary" it also applies to state-registered domestic partners and their children who lost PEBB health coverage due to the same types of events. Exception: You must be an employee, spouse, or qualified tax dependent to be eligible to continue a Medical Flexible Spending Arrangement (FSA).

What if I decline continuation coverage?

If you decline continuation coverage before the due date, your PEBB coverage will end on the last day of the month you and your family member(s) stop being eligible. You may change your mind as long as you mail or hand-deliver a completed election form no later than 60 days from the date you receive the Initial Notice of COBRA and Continuation Coverage Rights.