Change your coverage

Learn the requirements to make changes to your PEBB Continuation Coverage.

Before you make a change to your health plan

Before you make a change it is important to:

  • Make sure the health plan is available in your area.
  • Check the plan’s provider directory or contact your plan to make sure your provider is in the plan’s network.
  • Compare monthly plan costs (premiums).
  • Compare benefits and your costs for care (deductibles, coinsurance, and/or copays.)

How to make changes

To make changes, such as enroll a dependent or elect a different health plan, you must complete and submit the required form(s) during the annual open enrollment or when a special open enrollment event occurs, within the timelines listed below.

To make a change during the PEBB Program’s annual open enrollment:
The PEBB Program must receive the appropriate PEBB Continuation Coverage (COBRA) Election/Change or PEBB Continuation Coverage (Unpaid Leave) Election/Change form between November 1 and 30. You may also make some changes using PEBB My Account.

To make a change when a special open enrollment event occurs:
The PEBB Program must receive the appropriate PEBB Continuation Coverage (COBRA) Election/Change or PEBB Continuation Coverage (Unpaid Leave) Election/Change form no later than 60 days after the event that created the special open enrollment along with proof of the event that created the special open enrollment (see PEBB Program Policy Addendum 45-2A for a list of valid documents). If adding a newborn or newly adopted child, and adding the child increases your premium, your employer must receive this form no later than 60 days after the birth or adoption.

Also, if you or your eligible dependent are interested in enrolling in a PEBB Medicare supplement plan, you have 6 months from the date of your enrollment in Medicare Part B to enroll.

In most cases, the requested change will occur the first day of the month after the date of the event or the date the PEBB Program receives your required, completed enrollment form(s), whichever is later. If that day is the first of the month, the requested coverage begins on that date.

Changes you can make any time

There are some changes you can make any time during the year without a special open enrollment event.

Plan change requirements

  • You can only change medical or dental plans during the PEBB Program's annual open enrollment (November 1 through 30) or if a special open enrollment event occurs.
  • All eligible dependents must enroll in the same health plan. (Dependents can have different providers.)
  • If you have a provider you want to stay with, contact the new health plan or check the plan’s provider directory to make sure your provider is in the plan’s network.
  • You may be enrolled in only one PEBB medical or dental plan. If you and your spouse or state-registered domestic partner are both eligible subscribers, you need to choose which of you will cover yourselves and your eligible children (including adult children who are also eligible for PEBB insurance coverage as an employee). Enrolled dependents will be listed on one account, not both.

Special open enrollment

The PEBB Program allows changes outside of the PEBB Program annual open enrollment when certain events create a special open enrollment. The change must correspond to and be consistent with the event that creates the special open enrollment. You must provide proof of the event that created the special open enrollment (for example, a marriage or birth certificate).

These changes may be allowed as a special open enrollment:

If this event happens... Add dependent Change medical plan Change dental plan
Marriage, registering a state-registered domestic partnership as defined by Washington Administrative Code 182-12-109, birth, adoption, or assuming a legal obligation for support in anticipation of adoption. Yes Yes Yes
Child becomes eligible as an extended dependent through legal custody or legal guardianship. Also complete the PEBB Extended Dependent Certification form and the PEBB Declaration of Tax Status form. Yes Yes Yes
Subscriber or dependent loses eligibility for other coverage under a group health plan or through health insurance, as defined by the Health Insurance Portability and Accountability Act (HIPAA). Yes Yes Yes
Subscriber has a change in employment status that affects the subscriber’s or dependent’s eligibility for the employer contribution toward their employer-based group health plan. Yes Yes Yes
Subscriber's dependent has a change in their own employment status that affects their eligibility for the employer contribution under their employer-based group health plan. Yes Yes Yes
Subscriber or dependent has a change in enrollment under another employer-based group health insurance plan during its annual open enrollment that does not align with the PEBB Program’s annual open enrollment. Yes No No
Subscriber’s dependent moves from outside the United States to live within the United States, or from within the United States to live outside of the United States, and that change in residence resulted in the dependent losing their health insurance. Yes No No
Subscriber or dependent has a change in residence that affects health plan availability. No Yes Yes
A court order requires the subscriber or any other individual to provide insurance coverage for an eligible child of the subscriber. Yes Yes Yes
Subscriber or dependent becomes entitled to or loses eligibility for Medicaid or a state Children’s Health Insurance Program (CHIP). Yes Yes Yes
Subscriber or a dependent becomes eligible for a state premium assistance subsidy for PEBB health plan coverage from Medicaid or a state CHIP. Yes Yes Yes
Subscriber or dependent becomes entitled to Medicare or loses eligibility for Medicare, or enrolls in or terminates enrollment in a Medicare Part D plan. No Yes Yes
Subscriber’s or dependent’s current health plan becomes unavailable because the subscriber or enrolled dependent is no longer eligible for a health savings account (HSA). No Yes Yes
Subscriber or dependent experiences a disruption of care for active and ongoing treatment that could function as a reduction in benefits for the subscriber or their dependent (requires approval by the PEBB Program). No Yes Yes

For more details about the changes you can make during these events, see PEBB Program Policy Addendum 45-2A and refer to Washington Administrative Code (WAC):

The PEBB Program's annual open enrollment

From November 1 to 30 each year, you can make changes to your PEBB Program account that will take effect January 1 of the following year.

During open enrollment you can:

  • Change your medical or dental plans.
  • Enroll or remove eligible dependents from your PEBB medical or dental plan.

Note: If you enroll a dependent, you may need to provide proof of the dependent’s eligibility with your enrollment form before they can be enrolled. Visit Dependent verification to find a list of acceptable dependent verification documents.

Changes you can make online

During the PEBB Program's annual open enrollment you can make changes online using PEBB My Account. You can:

  • Change your medical and/or dental plan(s).
  • Remove dependents from your coverage.

Please print or save your confirmation page when you’ve completed your changes. Check back in a two business days to verify the coverage you selected and your spousal or registered domestic partner coverage attestation is correct.

When you submit an online plan change, please wait two business days to make any additional online plan changes.

Switching between PEBB Continuation Coverage (COBRA) and the Marketplace

If you sign up for PEBB Continuation Coverage, you can switch to a Marketplace plan during the Marketplace’s open enrollment period or if you have another qualifying event that triggers a special enrollment period (such as marriage or birth of a child). If you cancel (terminate) PEBB Continuation Coverage early without another qualifying special open enrollment event, you will have to wait to enroll in Marketplace coverage until the next Marketplace open enrollment period. You could end up without any health plan coverage in the interim and may be charged high out-of-pocket costs if you receive health care services.

Once your PEBB Continuation Coverage expires, you will be eligible to enroll in Marketplace coverage through a special enrollment period, even if the Marketplace open enrollment period has ended.

If you sign up for Marketplace coverage instead of PEBB Continuation Coverage, you cannot switch to PEBB Continuation Coverage under any circumstances.