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Am I eligible?

The PEBB Program offers two types of continuation coverage: COBRA and Unpaid Leave. Both options are temporary extensions of PEBB coverage.

Continuation Coverage (COBRA and Unpaid Leave) enrollment timelines and the maximum coverage period are extended during the COVID-19 state of emergency.

What continuation coverage options are available?

The PEBB Program offers two types of continuation coverage.

PEBB Continuation Coverage (COBRA)

A temporary extension of PEBB health plan coverage available to PEBB members who are qualified beneficiaries under federal Consolidated Omnibus Budget Reconciliation Act (COBRA) rules.

The Health Care Authority (HCA) also extends PEBB Continuation Coverage (COBRA) to state-registered domestic partners and their children. Coverage may be temporarily extended only if a PEBB member experiences a qualifying event.

PEBB Continuation Coverage (Unpaid Leave)

A temporary extension of PEBB insurance coverage for employees who lose eligibility for the employer contribution toward PEBB benefits due to specific types of leave, such as active duty in the uniformed services and authorized leave without pay.

What is a qualified beneficiary? A qualified beneficiary is a covered employee, the employee’s covered spouse, and covered dependent children during a period of continuation coverage.

Am I eligible?

For COBRA

Each person who loses their PEBB health plan coverage due to a qualifying event has an independent election right to PEBB Continuation Coverage (COBRA).

Real-world example

If an employee loses their PEBB employer-based group health plan due to a qualifying event, their eligible spouse or state-registered domestic partner (SRDP) may choose continuation coverage, even if the employee does not. Either the employee or their spouse or SRDP may choose continuation coverage for any dependent children.

For Unpaid Leave

Employees who lose their PEBB employer-based group health plan due to a qualifying event may choose PEBB Continuation Coverage (Unpaid Leave) for themselves and their dependents. The employee must choose this coverage for dependents to have coverage. Dependents do not have independent election rights.

Qualifying events 

A qualifying event is a life event that causes loss of coverage. See related laws and rules at the bottom of this page for more information. 

Employee

  • Your employment ended for any reason other than gross misconduct.
  • Your hours of employment were reduced below the number of hours required to be eligible for the employer contribution toward PEBB benefits.

Spouse

  • Your spouse (the employee or retiree) died. You may qualify for PEBB Continuation Coverage (COBRA) or PEBB retiree insurance coverage.
  • Your spouse’s hours of employment were reduced.
  • Your spouse’s employment ended for any reason other than gross misconduct.
  • You and your spouse have experienced a divorce, annulment, or dissolution of marriage.

State-registered domestic partner (SRDP)

  • Your SRDP (the employee or retiree) died. You may qualify for PEBB Continuation Coverage (COBRA) or PEBB retiree insurance coverage.
  • Your SRDP’s hours of employment were reduced.
  • Your SRDP’s employment ended for any reason other than gross misconduct.
  • Your state-registered domestic partnership ended.

Dependent children

  • Your parent (the employee or retiree) died.
  • Your parent’s hours of employment were reduced.
  • Your parent’s employment ended for any reason other than gross misconduct.
  • Your eligibility for PEBB health plan coverage as a dependent child ended.

SRDP's child

  • Your parent’s SRDP (the employee or retiree) dies.
  • Your parent’s SRDP’s hours of employment are reduced.
  • Your parent’s SRDP’s employment ends for any reason other than gross misconduct.
  • Your eligibility for PEBB health plan coverage as a dependent child ended.

Retiree or retiree's dependent

  • You are a retiree and your employer group ends participation in PEBB health plan coverage.
  • You are a retiree and the Department of Retirement Systems has determined that you are no longer disabled, so your pension has stopped.
  • You are a retiree and you or your dependent did not meet the procedural requirement to enroll or stay enrolled in Medicare Part A and Part B as required by PEBB Program rules.
  • You are on authorized leave without pay from your employer.
  • Your employment ends due to a layoff.
  • You reverted to a position that is not eligible for the employer contribution toward PEBB benefits.
  • 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 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.

If you are called to active duty or on approved educational leave, you may continue your long-term disability insurance.

How long does coverage last?

Your maximum coverage period is determined by the qualifying event that caused you to lose PEBB coverage. In some situations, coverage can end before the maximum coverage period. See related laws and rules at the bottom of the page for more information.

Eligible member

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

Maximum continuation coverage (COBRA) period

18 months

Additional months of coverage may be available under PEBB Continuation Coverage (Unpaid Leave).

Note: In certain circumstances, qualified beneficiaries eligible for 18 months of PEBB Continuation Coverage (COBRA) may become eligible for an extension. A disability extension provides an additional 11 months of coverage (for a total maximum of 29 months). An extension due to a second qualifying event provides an additional 18 months of coverage (for a total maximum of 36 months). 

Eligible member

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

Maximum continuation coverage (COBRA) period

Up to 36 months, measured from the date of the employee’s Medicare enrollment.

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

29 months

An employee who is no longer eligible for PEBB Continuation Coverage (Unpaid Leave), but who has not used the maximum number of months allowed under PEBB Continuation Coverage (COBRA), may continue medical, dental, or both for the remaining months allowed under COBRA.

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

29 months

An employee who is no longer eligible for PEBB Continuation Coverage (Unpaid Leave), but who has not used the maximum number of months allowed under PEBB Continuation Coverage (COBRA), may continue medical, dental, or both for the remaining months allowed under COBRA.

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

29 months

An employee who is no longer eligible for PEBB Continuation Coverage (Unpaid Leave), but who has not used the maximum number of months allowed under PEBB Continuation Coverage (COBRA), may continue medical, dental, or both for the remaining months allowed under COBRA.

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

29 months

An employee who is no longer eligible for PEBB Continuation Coverage (Unpaid Leave), but who has not used the maximum number of months allowed under PEBB Continuation Coverage (COBRA), may continue medical, dental, or both for the remaining months allowed under COBRA.

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

29 months

An employee who is no longer eligible for PEBB Continuation Coverage (Unpaid Leave), but who has not used the maximum number of months allowed under PEBB Continuation Coverage (COBRA), may continue medical, dental, or both for the remaining months allowed under COBRA.

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

29 months

An employee who is no longer eligible for PEBB Continuation Coverage (Unpaid Leave), but who has not used the maximum number of months allowed under PEBB Continuation Coverage (COBRA), may continue medical, dental, or both for the remaining months allowed under COBRA.

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

18 months

An employee who is no longer eligible for PEBB Continuation Coverage (Unpaid Leave), but who has not used the maximum number of months allowed under PEBB Continuation Coverage (COBRA), may continue medical, dental, or both for the remaining months allowed under COBRA.

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

12 months

Faculty and seasonal employees who use up the 12 months of PEBB Continuation Coverage (Unpaid Leave) may continue coverage for the remaining months allowed under PEBB Continuation Coverage (COBRA).

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

29 months

If the dismissal is upheld and the employee has not used the maximum number of months allowed under PEBB Continuation Coverage (COBRA), they may continue medical, dental, or both for the remaining months allowed under COBRA.

Eligible member

  • Spouse
  • State-registered domestic partner
  • Children

Note: If the qualifying event is the death of an emergency service personnel killed in the line of duty, the death of an employee or retiree, or death of an elected or full-time appointed official, 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 their death, and children may continue coverage until they lose eligibility for PEBB benefits.

Maximum continuation coverage (Unpaid Leave) period

36 months

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

Eligible member

  • Spouse
  • State-registered domestic partner
  • Step-children

Maximum continuation coverage (COBRA) period

36 months

Eligible member

Children

Maximum continuation coverage (COBRA) period

36 months 

Eligible member

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

*Employee who enrolled in PEBB retiree insurance coverage after September 15, 1991, and is currently enrolled.

Maximum continuation coverage (COBRA) period

18 months

Note: In certain circumstances, qualified beneficiaries eligible for 18 months of PEBB Continuation Coverage (COBRA) may become eligible for an extension. A disability extension provides an additional 11 months of coverage (for a total maximum of 29 months). An extension due to a second qualifying event provides an additional 18 months of coverage (for a total maximum of 36 months). 

Are there other options?

Yes. You and your dependents may have other coverage options through the Health Insurance Marketplace, Medicaid, or other group health plan coverage (such as a spouse’s plan).

Related laws and rules

Contact

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

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