How to determine eligibility

Find out if you're eligible for continuation coverage benefits.

What continuation coverage options are available?

The PEBB Program offers one or more ways for you and your dependents, if eligible, to continue PEBB coverage.

  1. PEBB Continuation Coverage (COBRA)
    A temporary extension of PEBB health plan coverage is available to PEBB members who loses eligibility for the employer contribution toward PEBB benefits and who qualifies for continuation coverage under the federal Consolidated Omnibus Budget Reconciliation Act (COBRA). RCW 26.60.015 and a PEBB policy resolution extends PEBB coverage for dependents, including state-registered domestic partners and their children, not otherwise eligible for COBRA. This means an employee's state-registered domestic partner and the state-registered domestic partner's children may continue PEBB insurance coverage on the same terms and conditions as spouses and other eligible dependents under COBRA. Coverage may be temporarily extended only if the PEBB member experiences a qualifying event.
  2. PEBB Continuation Coverage (Unpaid Leave)
    A temporary extension of PEBB health plan coverage, life insurance, and accidental death and dismemberment insurance as an alternative for employees who lose eligibility for the employer contribution toward insurance coverage due to specific types of leave or other qualifying events. Long-term disability (LTD) insurance may also be continued if you are eligible and choose to continue LTD coverage under PEBB Continuation Coverage (Unpaid Leave).
  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 for medical, dental, or both 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 to you and/or your dependents at the address(es) we have on record. The notice provides information on how to continue PEBB health plan coverage.

Who can elect continuation coverage?

Once the PEBB Program receives timely notice that a qualifying event has occurred, continuation coverage will be offered to each qualified beneficiary. Each covered dependent who loses PEBB health plan coverage will have an independent right to elect PEBB Continuation Coverage (COBRA). Dependents do not have independent election rights to PEBB Continuation Coverage (Unpaid Leave) 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 election is not received by the PEBB Program no later than 60 days from the date the enrollee’s PEBB health plan coverage ended or from the postmark date on the PEBB Continuation Coverage Election Notice, whichever is later, will lose their right to enroll in continuation coverage.

What is PEBB Continuation Coverage (COBRA)?

PEBB Continuation Coverage (COBRA) is a continuation of health plan coverage offered when PEBB health plan coverage ends because of a qualifying event. You may continue coverage for medical, dental, or both. After a qualifying event occurs, the PEBB Program is required to offer PEBB Continuation Coverage (COBRA) to each person who is a qualified beneficiary, and to state-registered domestic partners and their children, based on RCW 26.60.015 and PEBB policy resolution that extends PEBB health plan coverage for dependents not otherwise eligible under federal COBRA rules. An employee's state-registered domestic partner and the state-registered domestic partner's children may continue PEBB insurance coverage for medical, dental, or both on the same terms and conditions as spouses and other eligible dependents under COBRA.

You, your spouse, your dependent children, and your state-registered domestic partner and their children could become qualified beneficiaries if coverage in a PEBB health plan is lost because of a qualifying event. Each qualified beneficiary has independent election rights. Those choosing to elect PEBB Continuation Coverage (COBRA) must pay the monthly premium and applicable premium surcharges. The type of qualifying event determines how long you may continue PEBB Continuation Coverage (COBRA).

Who is entitled to PEBB Continuation Coverage (COBRA)?

Qualified beneficiaries (employees, spouses or former spouses, or dependent children) under federal COBRA rules, or current or former state-registered domestic partners and their dependent children who are not qualified beneficiaries under federal COBRA rules, are entitled to continue PEBB health plan coverage by electing PEBB Continuation Coverage (COBRA) if they lost PEBB health plan coverage due to a qualifying event (see below).

Qualifying events for PEBB Continuation Coverage (COBRA)

Employee

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

Retiree

  • Your employer group ends participation in PEBB health plan coverage. (Retirees of educational service districts can continue their PEBB retiree insurance coverage, even if their district discontinues participation.)
  • 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 and your spouse divorce. If your spouse (the employee or retiree) reduces or cancels (terminates) 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.

State-registered domestic partner

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

Dependent children

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

State-registered domestic partner's child

  • 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’s (the employee’s) hours of employment are reduced.
  • Your parent’s state-registered domestic partner’s (the employee’s) employment ends for any reason other than gross misconduct.
  • Your eligibility for PEBB health plan coverage as a dependent child ends.

Children born to or placed for adoption with the covered employee during the PEBB Continuation Coverage (COBRA) coverage period

A child born to, adopted by, or placed for adoption with a covered employee during a period of PEBB Continuation Coverage (COBRA) is considered a qualified beneficiary under federal COBRA rules. The child may be enrolled in PEBB Continuation Coverage (COBRA) due to a special open enrollment event or during the PEBB Program’s annual open enrollment period. Coverage can last for the duration of the PEBB Continuation Coverage (COBRA) coverage period, measured from the original qualifying event date. To be enrolled in PEBB health plan 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 Program during the covered employee’s period of employment, is entitled to the same rights to PEBB Continuation Coverage (COBRA) as an eligible dependent child of the covered employee.

Who is entitled to PEBB Continuation Coverage (Unpaid Leave)?

If you lose PEBB health plan coverage due to one of the events listed below, you are entitled to PEBB Continuation Coverage (Unpaid Leave).

Qualifying events for PEBB Continuation Coverage (Unpaid Leave)

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

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

What is a qualified beneficiary?

A qualified beneficiary is an employee, spouse, or their dependent child who lost PEBB health plan coverage due to a qualifying event and is entitled to continue their PEBB Continuation Coverage under federal COBRA rules. State-registered domestic partners and their children who lost PEBB health coverage due to the same types of events may choose PEBB Continuation Coverage (COBRA), under Washington State law (RCW 26.60.015 and PEBB policy resolution, under the same terms and conditions as spouses and other eligible dependents under federal COBRA rules. 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 (as defined in IRC §152(c)(2)) to be eligible to continue a Medical Flexible Spending Arrangement (FSA). If you are enrolled in a Medical FSA and your dependents will have an opportunity to continue making contributions to their medical FSA by electing COBRA if on the date of the qualifying event, as described under 42 U.S.C. Sec. 300bb-3, your Medical FSA has a greater amount in remaining benefits than remaining contribution payments for the current year. The election must be received by the contracted vendor no later than 60 days from the date the PEBB health plan coverage ended or from the postmark date on the election notice sent by the contracted vendor, whichever is later.

What if I decline PEBB Continuation Coverage?

If you reject or decline PEBB Continuation Coverage before the due date, you  may change your mind as long as the PEBB Program receives your completed election form(s) no later than 60 days from the date your PEBB health plan coverage ended or from the postmark date on the PEBB Continuation Coverage Election Notice, whichever is later.