How to enroll

Steps to become a COBRA or continuation coverage subscriber.

How do I elect Continuation Coverage?

To choose PEBB Program Continuation Coverage, send either the completed COBRA Continuation Coverage or Continuation Coverage Election/Change form no later than 60 days after the date your employer-sponsored coverage ends or from the postmark on the Continuation Coverage Election Notice packet sent to you, whichever is later.

Oral communications (in person or by telephone) and electronic communications (fax or email) are not acceptable methods of election, and will not preserve your Continuation Coverage rights. If you do not submit completed form(s) by the deadline, your PEBB insurance coverage will end on the last day of the month following the date of the qualifying event.

Important! If you, your dependents, or your representative does not notify your employer or the PEBB Program in writing no later than 60 days after the qualifying event date or the date eligibility ceases, whichever occurs later, you and your covered dependents will lose the right to elect COBRA or Continuation Coverage.

Who must provide notice when I lose eligibility for PEBB insurance coverage?

Your employer must notify the PEBB Program when:

  • Your (the employee’s) employment ends.
  • Your (the employee’s) hours of employment are reduced.
  • You (the employee) die.
  • You (the retiree) lose eligibility for PEBB retiree insurance because your employer group ceases participation in PEBB health coverage. Retirees of school districts and educational service districts can continue PEBB retiree coverage, even if their district discontinues participation or never participated with the PEBB Program.

You, your dependents, or a representative acting on your behalf must provide written notice to your employer's personnel, payroll, or benefits office (if you're an employee), or the PEBB Program (if you're a retiree) when:

  • You divorce or terminate a registered domestic partnership.
  • Your child loses eligibility (loss of dependent status).
  • You lose eligibility for PEBB retiree insurance because the Department of Retirement Systems (DRS) determines you are no longer disabled and stops your pension.

Your dependents or a representative acting on your behalf must provide written notice to the PEBB Program if:

  • You (the employee or retiree) die.

Deadline to provide notice

You, your dependents, or your representative must provide written notice to your employer’s personnel, payroll, or benefits office (if you’re an employee), or the PEBB Program (if you’re a retiree) no later than 60 days after whichever occurs later:

  1. The date of the qualifying event, or
  2. The date you or a covered dependent loses (or would lose) eligibility for PEBB coverage due to a qualifying event.

Example 1: If you divorce your spouse on June 15, the qualifying event date is June 15. Your former spouse loses eligibility for PEBB benefits on the last day of the month in which the divorce occurred (June 30). The PEBB Program must receive written notice of the qualifying event no later than 60 days after the qualifying event date or the date eligibility ends, whichever occurs later. In this case, eligibility for PEBB coverage ends on June 30, after the qualifying event date (June 15). Therefore, your employer or the PEBB Program must receive written notice no later than 60 days after June 30.

Example 2: You cancel coverage for your spouse on December 31 in anticipation of a divorce, but your divorce is not final until June 15. The PEBB Program must receive written notice of the qualifying event no later than 60 days after the qualifying event date (June 15) or the date PEBB coverage ends (December 31). In this case, the qualifying event date occurs June 15, after PEBB coverage ends. Therefore, your employer or the PEBB Program must receive written notice no later than 60 days after June 15.

Once your employer or the PEBB Program is notified of the qualifying event, a PEBB Continuation Coverage Election Notice will be mailed to the address you provide.

What information is needed to provide notice of a qualifying event?

Any notice you, your dependent, or your representative provides must include:

  1. The name and address of the employee or retiree who is (or was) covered.
  2. The name, address, telephone number, and signature of the person providing the notice.
  3. The names and addresses of all qualified beneficiaries who lost coverage as a result of the qualifying event.
  4. The qualifying event and the date it happened.

And

If providing notice of a divorce or termination of state-registered domestic partnership: In addition to items 1–4 above, include proof of the divorce or termination of state-registered domestic partnership. If you notify the PEBB Program that your coverage was reduced or cancelled in anticipation of a divorce or termination of a state-registered domestic partnership, your notice must include proof that your coverage was reduced or cancelled.

And

If providing notice of a disability (or that a disability has ended), your notice must include items 1–4 above and:

  • The name and address of the disabled qualified beneficiary.
  • The date the qualified beneficiary became disabled.
  • The names and addresses of all qualified beneficiaries who are receiving continuation coverage.
  • A copy of the Social Security Administration's letter showing the disability determination date or a statement from the Social Security Administration that the qualified beneficiary is no longer disabled.

If providing notice of a second qualifying event, your notice must include items 1–4 above and:

  • The second qualifying event and the date it happened.
  • The names and addresses of all qualified beneficiaries who are receiving continuation coverage.
  • Proof of the second qualifying event.

How long does continuation coverage last?

COBRA coverage and PEBB Continuation Coverage provide temporary health plan coverage. Maximum coverage periods can last anywhere from 12 to 36 months and are based on the qualifying event that caused you or your covered dependent to lose PEBB health coverage. A table listing the maximum coverage periods based on the qualifying events is below.

Coverage can end before the maximum coverage period if:

  • Automatically canceled because premiums are not paid in full on time or the employer stops providing any group health plan for its employees.
  • Automatically canceled because you become entitled to Medicare or become covered under other group health coverage.
  • A qualified beneficiary stops being disabled.
  • You ask to cancel coverage.

For details consult the PEBB Continuation Coverage Election Notice booklet.

 

Qualifying event
(reason that caused you or your covered dependent to lose PEBB health plan coverage)

Eligible member Maximum continuation coverage period

Termination of employment (other than for gross misconduct) or reduction of hours

  • Employee
  • Spouse
  • State-registered domestic partner
  • Children

18 months1

Additional months of coverage may be available under PEBB Continuation Coverage (Leave Without Pay [LWOP]).

Entitled to Medicare within 18 months before termination of employment or reduction of hours

  • Spouse
  • State-registered domestic partner
  • Children

Up to 36 months, measured from the date of the employee's Medicare entitlement.

  • Authorized leave without pay
  • Employment ends due to a layoff
  • Receiving time-loss benefits under workers' compensation
  • Applying for disability retirement
  • Called to active military duty, as defined by the Uniformed Services Employment and Reemployment Rights Act (USERRA)
  • Approved educational leave

Employee

Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Leave Without Pay [LWOP]).

29 months

An employee who is no longer eligible for PEBB Continuation Coverage (LWOP), but who has not used the maximum number of months allowed under COBRA, may continue medical, dental, or both for the remaining difference in months allowed under COBRA (see WAC 182-12-133(1)).

Reverting (for reasons other than a layoff)to a position that is not eligible for the employer contribution toward PEBB insurance coverage

Employee

Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Leave Without Pay [LWOP]).

18 months1

An employee who is no longer eligible for PEBB Continuation Coverage (LWOP), but who has not used the maximum number of months allowed under COBRA, may continue medical, dental, or both for the remaining difference in months allowed under COBRA (see WAC 182-12-141).

Faculty member or seasonal employee who is between periods of eligibility

Employee

Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Leave Without Pay [LWOP]).

12 months

Faculty and seasonal employees who use up to 12 months of PEBB Continuation Coverage (LWOP) may continue coverage for the remaining difference in months allowed under COBRA (see WAC 182-12-142).

Awaiting hearing of a dismissal action

Employee

Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Leave Without Pay [LWOP]).

29 months

If the dismissal is upheld and the employee has not used the maximum number of months allowed under COBRA, he or she may continue medical, dental, or both for the remaining difference in months allowed under COBRA (see WAC 182-12-148).

Death of an employee or retiree2

  • Spouse
  • State-registered domestic partner
  • Children

36 months (from the date employer-based coverage ended)

PEBB retiree insurance coverage may also be available in certain cases.

See WACs 182-12-180, 182-12-250, and 182-12-265.

Divorce or termination of a state-registered domestic partnership

  • Spouse
  • State-registered domestic partner
  • Children

36 months (from the date coverage ended)

Child loses eligibility under PEBB rules

Children 36 months

An employer group terminates participation with the PEBB Program (with the exception of school districts, educational service districts, and charter schools)

  • A retired* or disabled employee
  • Spouse
  • State-registered domestic partner
  • Children

*Retiree must have enrolled in PEBB retiree insurance coverage after September 15, 1991.

18 months1

See WAC 182-12-146(4).

A retired or disabled employee (or his or her dependent) loses eligibility for PEBB retiree insurance coverage under WAC 182-12-171

  • A retired or disabled employee
  • Spouse
  • State-registered domestic partner
  • Children

18 months1

See WAC 182-12-146(5).

In certain circumstances, qualified beneficiaries entitled to 18 months of continuation coverage may become entitled to a disability extension of an additional 11 months (for a total maximum of 29 months) or an extension of an additional 18 months due to the occurrence of a second qualifying event (for a total maximum of 36 months) as described under When can continuation coverage be extended?

2 If the qualifying event is the death of an emergency service personnel killed in the line of duty (see WAC 182-12-250), the death of an employee or retiree (see WAC 182-12-265), or death of an elected or appointed official (WAC 182-12-180), surviving dependents may be eligible for PEBB retiree insurance coverage. Under PEBB retiree insurance coverage, the spouse or state-registered domestic partner may continue coverage until his or her death, and children may continue coverage until they lose eligibility for PEBB benefits according to WAC 182-12-260.

When can continuation coverage be extended?

If you or your qualified beneficiaries* are enrolled in COBRA coverage for 18 months due to the employee’s termination of employment or reduction of hours, there are two ways in which this 18-month period of continuation coverage can be extended:

  1. When you or a qualified beneficiary is determined disabled by the Social Security Administration.
  2. When a second qualifying event occurs.

A Medical Flexible Spending Arrangement (FSA) may only be continued through the year in which the original qualifying event occurred. Therefore, the extension of coverage rule does not apply to Medical FSAs, and they cannot be extended under any circumstances.

Disability extension of coverage

If the Social Security Administration determines that any qualified beneficiary* is disabled, you and all of the qualified beneficiaries in your family may be entitled to receive up to 11 months of additional continuation coverage (for a total of 29 months). This extension is available only to those individuals who are receiving continuation coverage because of the covered employee’s termination of employment or reduction of hours.

The disability must have started before the 61st day after the covered employee’s termination of employment or reduction in hours, and must last at least until the end of the 18-month continuation coverage period.

The disability extension is available only if you notify the PEBB Program in writing and submit a COBRA election/change (Continuation Coverage) form and a copy of the disability award letter from the Social Security Administration no later than 60 days after the last of the following events:

  • The date of the Social Security Administration’s disability determination.
  • The date of the covered employee’s termination of employment or reduction of hours.
  • The date the qualified beneficiary loses (or would lose) coverage under PEBB rules as a result of the covered employee’s termination of employment or reduction of hours.
  • The date the PEBB Program mails a Continuation Coverage Election Notice to the qualified beneficiary, informing the beneficiary of his or her responsibility and the procedures to notify the PEBB Program.

You must also provide this notice within 18 months after the covered employee’s termination of employment or reduction of hours to be entitled to a disability extension. If the notice procedures are not followed or if the notice is not submitted to the PEBB Program during the 60-day notice period and within 18 months after the covered employee’s termination of employment or reduction of hours, then there will be no disability extension of COBRA or PEBB Continuation of Coverage.

The right to the disability extension may be terminated if the Social Security Administration determines that the disabled qualified beneficiary is no longer disabled. You or your qualified beneficiaries have 30 days after the Social Security Administration’s determination to notify the PEBB Program when a qualified beneficiary is no longer disabled.

Second qualifying event extension of coverage

If your qualified beneficiary* experiences a second qualifying event while receiving 18 months of Continuation Coverage (or 29 months, if the second event occurs during the disability extension), he or she may be entitled to receive up to an additional 18 months of continuation coverage, for a maximum of 36 months of continuation coverage.

To qualify for a second qualifying event extension of coverage, the second event must:

  • Occur during the initial continuation coverage period resulting from termination of employment, reduction of hours, or the retiree’s loss of PEBB Program retiree insurance due to termination of employer group participation with PEBB Program health coverage; and
  • Cause a qualified beneficiary* to lose coverage under PEBB Program rules if the first qualifying event had not occurred. This includes:**
    • The employee’s or retiree’s death.
    • Divorce.
    • Termination of a registered domestic partnership.
    • The dependent child loses eligibility for coverage under the PEBB Program rules.

Note: The second qualifying event extension is not available when an employee becomes entitled to Medicare after his or her termination of employment or reduction of hours. However, the employee and covered dependents may remain enrolled in COBRA for the duration of the COBRA coverage period.

Eligible dependents must have been covered under the plan on the day before the first qualifying event. Newborns or adopted children added after the first qualifying event are also eligible for the second qualifying event extension.

To request a second qualifying event extension, you or your qualified beneficiary must provide notice of the qualifying event to the PEBB Program in writing and provide information as noted in What information is needed to provide notice of a qualifying event no later than 60 days after the last of the following events:

  • The date of the second qualifying event.
  • The date the qualified beneficiary would lose coverage under PEBB Program rules as a result of the second qualifying event.
  • The date the PEBB Program provides the qualified beneficiary with a Summary Plan Document (also called a Certificate of Coverage or benefits booklet) either in print or online, informing the beneficiary of his or her responsibility and the procedures to notify the PEBB Program.
  • The date the PEBB Program mails a Continuation Coverage Election Notice to the qualified beneficiary, informing the beneficiary of his or her responsibility and the procedures to notify the PEBB Program.

 

*State-registered domestic partners and their children who lost coverage due to a qualifying event as described under Who is entitled to PEBB Continuation Coverage are allowed to extend the period of continuation coverage in the same situations as a spouse or child who is a qualified beneficiary.

**Also, termination of a state-registered domestic partnership is considered a second qualifying event for these state-registered domestic partners and their children.

What forms do I need?

COBRA

Continuation Coverage (Leave without pay)

More Forms