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Special open enrollment

Some life events (marriage, birth of a child, etc.) qualify you to make changes to your benefits outside of our annual open enrollment. We call these events and the time period you have to make changes (60 days) a "special open enrollment."

What changes can I make? 

Based on the event, the following changes may be allowed as a special open enrollment. 

As defined by Washington Administrative Code 182-12-109.

Action

Allowed?

Add dependents

Yes

Change medical plan

Yes
(A health plan change is not allowed when adding a SRDP or their child if they are not a tax dependent.)

Change dental plan Yes
(A health plan change is not allowed when adding a SRDP or their child if they are not a tax dependent.)

Documents to submit 

  • Marriage certificate
  • Certificate of state-registered domestic partnership or legal union.
  • Also provide evidence the marriage/partnership is still valid (e.g., a utility bill or bank statement) dated within the past six months showing both names.

Birth, adoption, or assuming a legal obligation for support in anticipation of adoption. 

Action

Allowed?

Add dependents

Yes

Change medical plan

Yes

Change dental plan Yes

Documents to submit

  • Birth certificate (or hospital certificate with child’s footprints)
  • Certificate or decree of adoption
  • Placement letter from adoption agency

All valid documents for proof of this event must show the name of the parent who is the subscriber, subscriber’s spouse, or the subscriber’s state-registered domestic partner.

Child becomes eligible as an extended dependent through legal custody or legal guardianship. 

Action

Allowed?

Add dependents

Yes

Change medical plan

Yes

Change dental plan Yes

Documents to submit 

  • Valid court order showing legal custody, guardianship, or temporary guardianship, signed by a judge or officer of the court and a signed PEBB Extended Dependent Certification.

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).

Action

Allowed?

Add dependents

Yes

Change medical plan

Yes

Change dental plan Yes

Documents to submit 

  • Certificate of creditable coverage.
  • Letter of termination of coverage from health plan or payroll or benefits office.
  • COBRA election notice.

Subscriber has a change in employment status that affects their eligibility for their employer contribution toward their employer-based group health plan. 

Action

Allowed?

Add dependents

Yes

Change medical plan

Yes

Change dental plan Yes

Documents to submit 

  • Employee hire letter from employer that contains information about benefits eligibility.
  • Employment contract.
  • Termination letter.
  • Letter of resignation.
  • Statement of insurance.
  • Certificate of coverage.

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.

Action

Allowed?

Add dependents

Yes

Change medical plan

Yes

Change dental plan Yes

Documents to submit 

  • Employee hire letter from their employer that contains information about benefits eligibility.
  • Employment contract.
  • Termination letter.
  • Letter of resignation.
  • Statement of insurance.
  • Certificate of coverage.

Subscriber or dependent has a change in enrollment under another employer-based group health plan during its annual open enrollment that does not align with the PEBB Program’s annual open enrollment.

Action

Allowed?

Add dependents

Yes

Change medical plan

No

Change dental plan No

Documents to submit 

  • Certificate of credible coverage
  • Letter of enrollment or termination of coverage from the health plan
  • Letter of enrollment or termination of coverage from the employer’s payroll or benefits office
  • Proof of waiver

Subscriber's dependent moves from another country to live within the United States or from the United States to another country and that change in residence resulted in the dependent losing their health insurance.

Action

Allowed?

Add dependents

Yes

Change medical plan

No

Change dental plan No

 Documents to submit

  • Visa or passport with date of entry
  • Proof of former and current residence (e.g. utility bill)
  • Letter or document showing coverage was lost (e.g. certificate of credible coverage).

Subscriber or dependent has a change in residence that affects health plan availability.

Action

Allowed?

Add dependents

No

Change medical plan

Yes

Change dental plan Yes

Documents to submit 

  • Proof of former and current residence (e.g. utility bill).
  • Certificate of credible coverage. 

 A court order requires the subscriber or any other individual to provide a health plan for an eligible child of the subscriber.

Action

Allowed?

Add dependents

Yes

Change medical plan

Yes

Change dental plan Yes

Documents to submit 

  •  Valid court order.

Subscriber or dependent enrolls in or loses eligibility for Apple Health (Medicaid) or a state Children’s Health Insurance Program (CHIP). 

Action

Allowed?

Add dependents

Yes

Change medical plan

Yes

Change dental plan Yes

Documents to submit 

  • Enrollment or termination letter from Medicaid or CHIP reflecting the date the subscriber or subscriber’s dependent enrolled in Medicaid or CHIP or the date at which the subscriber or subscriber’s dependent lost eligibility for Medicaid or CHIP.

Subscriber or a dependent becomes eligible for a state premium assistance subsidy for PEBB medical plan from Medicaid or a state CHIP.

Action

Allowed?

Add dependents

Yes

Change medical plan

Yes

Change dental plan Yes

Documents to submit 

  • Eligibility letter from Medicaid or CHIP.

Subscriber or dependent enrolls in or loses eligibility for Medicare, or enrolls in or terminates enrollment in a Medicare Advantage plan or Medicare Part D plan. 

Action

Allowed?

Add dependents

Yes
(The subscriber may enroll a dependent who lost eligibility for coverage under Medicare. Existing uncovered dependents who did not lose Medicare eligibility may not be enrolled.)

Change medical plan

Yes

Change dental plan Yes

Documents to submit 

  • Medicare benefit verification letter.
  • Copy of Medicare card.
  • Notice of denial of Medicare coverage.
  • Social Security denial letter.
  • Medicare entitlement or cessation of disability form.

Subscriber's or dependent’s current health plan becomes unavailable because the employee or dependent is no longer eligible for a health savings account (HSA). 

Action

Allowed?

Add dependents

No

Change medical plan

Yes

Change dental plan Yes

Documents to submit 

  • Cancellation letter from the health plan.
  • Coverage confirmation in a new health plan.
  • Medicare entitlement letter
  • Copy of current tax return claiming you as a dependent.

Subscriber or dependent experiences a disruption of care for active and ongoing treatment that could function as a reduction in benefits for the employee or their dependent (requires approval by the PEBB Program). 

Action

Allowed?

Add dependents

No

Change medical plan

Yes

Change dental plan 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):

How do I make changes? 

To take advantage of special open enrollments, you must submit the following forms and documentation to the PEBB Program no later than 60 days after the event.

(See PEBB Program Policy Addendum 45-2A for a list of valid documents.)

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 forms, whichever is later. If that day is the first of the month, the requested coverage begins on that date.

Contact

The PEBB Program
Phone: 1-800-200-1004 
(TRS: 711)
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