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Employer groups and Educational Service Districts
Information to help employer groups and non-represented employees of Educational Service Districts compare PEBB Program eligibility, benefits, and costs, as well as view the requirements to apply to join the PEBB Program.
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Counties, municipalities, political subdivisions, and tribal governments are eligible to purchase employee benefits through the Public Employees Benefits Board (PEBB) Program per RCW 41.05 and WAC 182-08.
PEBB Program group coverage is available only to entities and employees that perform governmental functions and are not controlled by private interests. PEBB Program group coverage is available to all employees, individual bargaining groups, or all nonrepresented employees of the group.
Your group may request inclusion of retirees covered under your current retiree health plan, subject to PEBB Program requirements outlined in WAC 182-08-237. Employees who retire after your group joins PEBB will be eligible for PEBB Program retiree coverage based on retiree eligibility rules. Coverage for retirees only is not available through the PEBB Program.
Eligibility criteria for employees are defined in WAC 182-12-114 and for dependents in WAC 182-12-260. The PEBB Program may negotiate different eligibility criteria for employer groups under RCW 41.05.065(4). Requests must be submitted in writing and approved by the PEBB Program. Additional information regarding group eligibility is in WAC 182-12-111.
Participating counties, municipalities, political subdivisions and tribal governments will incur an employer group rate surcharge that will be applied to the monthly rate. For additional information about the employer group rate surcharge contact PEBB Outreach and Training at 1-800-700-1555.
Educational Service Districts applying for nonrepresented employees are required to provide the documents described in steps 1 through 4 under the How to apply section below.
Educational Service District employees are eligible to continue enrollment or defer enrollment in PEBB Program retiree coverage based on retiree coverage rules.
The PEBB Program provides a comprehensive insurance package that includes:
Optional coverage is available for auto and home insurance.
Your employees may select any PEBB Program health plan available in their county of residence.
Your counties, municipalities, subdivisions, and tribal government may purchase the full benefits package of medical/vision, dental, life and AD&D, and long-term disability, or may purchase only medical/vision. Note: If your group selects the full benefits package, employees cannot waive dental, basic life, basic A&D, or basic long-term disability coverage.
Educational Service Districts purchase the full benefits package of medical/vision, dental, life and AD&D, and long-term disability.
View the employer group monthly premiums. Rates for employer groups change in January.
Applicants may use the Employer Group 2021 projected monthly cost tool to tabulate PEBB Program rates based on subscriber enrollment selections.
View the Educational Service District monthly premiums. Rates for Educational Service Districts change in August.
Applicants may use the Educational Service District 2021 projected monthly cost tool to tabulate PEBB Program rates based on subscriber enrollment selections.
When a group joins the PEBB Program, they are assessed a start-up fee based on the number of eligible employees. The following table outlines these start-up fees.
|Group size (includes employees)||Fee|
|Less than 100 potential enrollees||$10 per person|
|100 - 500 potential enrollees||$1,500|
|501 - 700 potential enrollees||$2,000|
|701 - 1,000 potential enrollees||$2,500|
|More than 1,000 potential enrollees||$4,000|
The application requirements for employer groups and Educational Service Districts vary depending upon the number of employees in the group.
- Groups with fewer than 500 employees must submit a complete application at least 60 days before the requested coverage effective date.
- Groups with 500 or more employees but fewer than 5,000 employees must submit a complete application at least 90 days before the requested coverage effective date.
- Groups with 5,000 or more employees must submit a complete application at least 120 days before the requested coverage effective date.
- A letter of application that includes:
- A reference to the group’s authorizing statute;
- A description of the organizational structure and a description of the employee bargaining unit or group of nonrepresented employees for which the group is applying;
- The group’s employee tax ID (TIN) number; and
- A statement of whether the group is requesting medical, dental, life and AD&D, and long-term disability insurance or medical/vision only. Note: Educational Service Districts must enroll in medical, dental, life and AD&D, and long-term disability insurance.
- A resolution from the group’s governing body authorizing the purchase of PEBB insurance coverage. Sample resolution
- A signed governmental function attestation document that attests to the fact that employees for whom the group is applying are governmental employees whose services are substantially all in the performance of essential governmental functions. Sample attestation
- A member level census file for all employees for whom the group is applying. The file must be provided in the format required and contain the following: demographic data, by member, with each member classified as employee, spouse or state-registered domestic partner, or child. Member Level Census Data
If the application is for a subset of the group’s employees (e.g., bargaining unit), the group must provide a member level census data file for all employees eligible under the current health plans who are not included in the census file above. This includes retired employees participating under the group’s current health plans. Member Level Census Data
- Historical claims and cost information that includes:
- Large claims history for 24 months by quarter that excludes the most recent 3 months,
- Ongoing large claims management report for the most recent quarter provided in the large claims history, and
- A summary of historical plan costs.
In addition, groups with 5,000 or more employees and organizations representing state civil service employees and the Washington Health Benefit Exchange, regardless of the number of employees, must also provide the following:
- An actuarial evaluation of the group provided by an actuary designated by the PEBB Program. The group must pay for the cost of the evaluation.
- An executive summary of benefits, a summary of benefits and certificate of coverage.
For additional information, contact PEBB Outreach and Training at 1-800-700-1555.
Send your application to:
PEBB Program Outreach and Training
Health Care Authority
P.O. Box 42684
Olympia, WA 98504-2684
HCA will review your application for compliance with HCA terms and conditions of participation. Groups with fewer than 5,000 employees will be notified by the PEBB Program in writing upon acceptance or denial of your application. Your application may be denied if your group fails to provide the required information and documents described here.
Groups with 5,000 employees or more and employee organizations representing state civil service employees and the Washington Health Benefit Exchange, regardless of the number of employees, will have their application approved or denied through the evaluation criteria described in WAC 182-08-240.
You will be notified by the PEBB Program in writing upon acceptance or denial of your application. If the application is denied, you may reapply for participation at any time. In addition, you may file an appeal.
The PEBB Program bills groups monthly. You will receive an invoice around the 25th of each month before the month of coverage. Payment in-full is due by the 20th of the month of coverage. For example, around May 25 an invoice will be sent for June coverage. Payment in-full for June coverage is due by June 20.
You are expected to provide your own PEBB Program account maintenance. Groups with more than 75 employees must manage entering account information into the PEBB Program insurance system (PAY1). The PEBB Program provides training.
Once your group joins the PEBB Program, participation is required for at least one full year and may only terminate at the end of a plan year, which the PEBB Program has identified as the end of December for employer groups. HCA will consider requests for mid-year terminations that meet criteria in Policy #90-1.
Employer groups that cancel their participation with the PEBB Program assume responsibility for the continued insurance of any employees on COBRA or continuation of coverage and all retirees per WAC 182-08-245(6).
The PEBB Program defines an employer group to include counties, municipalities, political subdivisions, the Washington health benefit exchange, tribal governments, and employee organizations representing state civil service employees. The full definition is in WAC 182-12-015.