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Am I eligible?

Your employer will determine if you are eligible for PEBB benefits based on your specific employment circumstance and whether you qualify for the employer contribution.

On April 2, 2020, the Public Employees Benefits Board (PEB Board) approved policy resolutions that establish temporary eligibility for PEBB coverage for certain job classes hired during the Governor’s state of emergency due to COVID-19.

Who is eligible?

  • Employees
  • Employees from an employer group
  • Higher-education faculty
  • Seasonal employees
  • Elected and full-time appointed officials

What if I'm eligible as a subscriber and a dependent?

You cannot enroll in medical or dental coverage under two PEBB accounts. If you are eligible as an employee and as a dependent under someone else’s account, visit Waive my coverage for options available to you.

Real-world example

You and your state-registered domestic partner (SRDP) are independently eligible for PEBB insurance coverage. Since you cannot have medical or dental coverage under two accounts, you decide to waive PEBB medical for yourself and enroll as a dependent on your SRDP's PEBB medical coverage.

I'm eligible for both PEBB and SEBB. What do I do?

You can enroll in health plans through only one program. If you enroll in both PEBB and SEBB benefits and do not take action to resolve the dual enrollment, the SEBB Program or PEBB Program will automatically enroll or disenroll you. Refer to related laws and rules at the bottom of this page.

Real-world example

You are eligible for PEBB benefits and your SRDP is eligible for SEBB benefits. Since you cannot have coverage under both programs, you decide to waive PEBB medical and dental for yourself and enroll as a dependent on your SRDP's SEBB medical, dental, and vision coverage.

How is eligibility determined?

Your employer determines if you are eligible. If you disagree with the determination, you can file an appeal. Refer to related laws and rules at the bottom of the page for more information.

If you are an employee from an employer group that receives PEBB benefits through a contract with HCA, such as a county, municipality, political subdivision, tribal government, or educational service district, contact your payroll or benefits office about eligibility.

You are eligible for PEBB benefits upon employment if your employer anticipates you will work: 

  • An average of at least 80 hours per month
  • For at least eight hours in each month
  • For more than six consecutive months

I'm not eligible. Can that change? 

Yes. If your employer determines you are not eligible, but:

  • Later revises the hours you are anticipated to work or the length of your employment such that you would meet the criteria described above, you become eligible for PEBB benefits on the day the revision is made.
  • Based on your work pattern you later meet the criteria described above, you become eligible for PEBB benefits on the first day of the month after the six month averaging period.

Can I "stack" hours?

Yes. You may also “stack” or combine hours worked in more than one position to establish and maintain eligibility as long as the work is within one state agency where you do one of the following:

  • Work two or more positions at the same time (concurrent stacking).
  • Move from one position to another (consecutive stacking).
  • Combine hours from a seasonal position to hours from a nonseasonal position or job.

You must notify your employer if you believe you are eligible for benefits based on stacking. Refer to related laws and rules at the bottom of this page for more information.

“Faculty” means an academic employee of an institution of higher education whose workload is not defined by work hours but whose appointment, workload, and duties directly serve the institution’s academic mission.

If you are faculty, you are eligible for PEBB benefits upon employment if your employer anticipates you will work half-time or more for the entire instructional year or equivalent nine-month period.

What if this doesn't happen? 

Becoming eligible after consecutive quarters/semesters

If your employer doesn’t anticipate that this will happen, then you are eligible for PEBB benefits at the beginning of the second consecutive quarter or semester of employment, if you are anticipated to work (or have actually worked) half-time or more. Spring and fall are considered consecutive quarters/semesters when first establishing eligibility for faculty that work less than half-time during the summer quarter/semester.

Becoming eligible due to increased workload

If you receive additional workload after the beginning of the anticipated work period (quarter, semester, or instructional year), and are anticipated to work (or have actually worked half-time or more) making your workload meet the eligibility criteria above, you become eligible when the revision is made.

Becoming eligible by working for more than one institution

You may become eligible by working as faculty for more than one higher-education institution. Faculty workloads may only be stacked with other faculty workloads to establish or maintain eligibility. When you work for more than one higher-education institution, you must notify all employing agencies that you work at more than one institution and may be eligible for PEBB benefits through stacking. A faculty becomes eligible for PEBB benefits through stacking when the employer anticipates they will work half-time or more for the entire instructional year or equivalent nine-month period.

Continuing coverage

You may continue any combination of medical, dental, life and AD&D insurance when you are between periods of eligibility and are not eligible for the employer contribution by self-paying for the benefits (for a maximum of 12 months).  Visit Am I eligible (for PEBB Continuation Coverage) for more information.

“Seasonal employee” means a state employee hired to work during a recurring, annual season with a duration of three months or more, and who is anticipated to return each season to perform similar work.

As a seasonal employee, you are eligible for PEBB benefits upon employment if you are anticipated to work:

  • An average of at least 80 hours per month
  • For at least eight hours each month
  • At least 3 consecutive months of the season. A season means any recurring, annual period of work at a specific time of year that lasts 3 to 11 consecutive months.

I'm not eligible. Can that change?

Yes, under the following situations: 

  • If your employer changes your anticipated work hours or anticipated length of employment to where you meet the eligibility criteria above, you become eligible when the revision is made.
  • If you are found ineligible for benefits but later work an average of at least 80 hours per month and work for at least eight hours in each month for more than six consecutive months, you become eligible the first of the month following the six-month averaging period.

Can I "stack" hours?

Yes. If you work in more than one position within one state agency, you may stack or combine hours to establish and maintain eligibility. You must notify your employing agency if you believe you are eligible for benefits through stacking. An employee becomes eligible for PEBB benefits through stacking when they meet the requirements described above.

Am I eligible in the off-season?

You may be. If you are a benefits-eligible seasonal employee who works a season of nine months or more, you are also eligible for the employer contribution through the off-season following each season worked, but the eligibility may not exceed a total of twelve consecutive calendar months for the combined season and off-season.

Continuing coverage

If you work a season of less than nine months, you are not eligible for the employer contribution during the off season. You may continue any combination of medical, dental, life and AD&D insurance when you are between periods of eligibility and not eligible for the employer contribution by self-paying for benefits for a maximum of 12 months. Visit Am I eligible? (PEBB Continuation Coverage) for more information.

As a legislator, you are eligible for PEBB benefits on the date your term begins. All other elected and full-time appointed officials of the legislative and executive branches of state government are eligible on the date their terms begin or the date they take the oath of office, whichever occurs first. 

Justices and judges

A justice of the Supreme Court and judges of the court of appeals and the superior courts become eligible for PEBB benefits on the date they take the oath of office.

Are my dependents eligible?

You may enroll your legal spouse, your state-registered domestic partner, your children, and your survivors. 

Learn more about dependent eligibility and survivors.

Related laws and rules

Contact

Your payroll or benefits office