The PEBB Program’s annual open enrollment is November 1 through 30. Learn more.

Change your coverage

Learn the requirements to make changes to your PEBB coverage. University of Washington employees must make changes through Workday.

Before you make a change to your health plan

Before you make a change, it is important to:

How to make changes

You must submit the appropriate form(s) to your personnel, payroll, or benefits office during the PEBB Program's annual open enrollment or when a special open enrollment event occurs.

Note: University of Washington employees must make changes through Workday.

To make a change during the PEBB Program’s annual open enrollment:

Your personnel, payroll, or benefits office must receive the appropriate PEBB Employee Enrollment/Change form during the PEBB Program's annual open enrolment (November 1 through 30). You may also make some changes using PEBB My Account. The enrollment change will become effective January 1 of the following year.

To make a change when a special open enrollment event occurs:

Your personnel, payroll, or benefits office must receive the appropriate PEBB Employee Enrollment/Change form no later than 60 days after the event that created the special open enrollment along with proof of the event that created the special open enrollment (See PEBB Program Administrative Policy Addendum 45-2A for a list of valid documents). However, if adding a newborn, newly adopted child, or child for whom the employee has assumed a legal obligation for support in anticipation of adoption, the employee should submit the required forms to the PEBB Program as soon as possible. If adding the child increases your premium, your employer must receive this form no later than 60 days after the date of birth, adoption, or date the legal obligation is assumed for support in anticipation of adoption.

Changes you can make any time

You can make some changes during the year without a special open enrollment event.

Note: University of Washington employees must make changes through Workday.

  • Change your name and/or address. Use the appropriate PEBB Employee Enrollment/Change form.
  • Remove dependent(s) from coverage due to loss of eligibility due to divorce, annulment, dissolution, or a qualifying event of a dependent ceasing to be eligible as a dependent child (required). Your personnel, payroll, or benefits office must receive the appropriate PEBB Employee Enrollment/Change form within 60 days of the last day of the month the dependent loses eligibility for health plan coverage. If a dependent child with a disability loses eligibility, the notice must be provided to the PEBB Program, in writing.
  • Change your life insurance beneficiary information. See the Life insurance page for details.
  • Apply for, cancel (terminate), or change coverage amounts for supplemental life and accidental death and dismemberment (AD&D) insurance. See the Life insurance page for details.
  • Apply for, cancel (terminate), or change auto or home insurance coverage. See the Auto & home insurance page for details.
  • Enroll in, cancel (terminate), or increase or decrease the waiting period for supplemental long-term disability coverage. Use the PEBB Long-Term Disability Enrollment/Change form. If you request to decrease the waiting period or enroll in optional LTD coverage later than 31 days after becoming eligible for PEBB benefits, you must also complete the PEBB Long-Term Disability Evidence of Insurability form. See the Long-term disability insurance page for details.
  • Start, stop, or change your contribution to your health savings account (HSA). Use the Employee Authorization for Payroll Deduction to Health Savings Account form.
  • Change your HSA beneficiary information. Use the Health Savings Account Beneficiary Designation form.
  • Change your or a dependent's tobacco use premium surcharge attestation. Use the PEBB Premium Surcharge Attestation Change form or log into PEBB My Account.

Plan change requirements

  • You can only change medical or dental plans during the PEBB Program's annual open enrollment (November 1 through 30) or if a special open enrollment event occurs.
  • All eligible dependents must enroll in the same health plan. (Dependents can have different providers.)
  • If you have a provider you want to stay with, contact the new plan or check the plan’s provider directory to make sure your provider is in that plan’s network.
  • You may be enrolled in only one PEBB medical or dental plan. If you and your spouse or state-registered domestic partner are both eligible subscribers, you need to choose which of you will cover yourselves and your eligible children (including adult children who are also eligible for PEBB coverage as an employee). Enrolled dependents will be listed on one account, not both. However, you must enroll in dental, basic life insurance, basic AD&D insurance, and basic LTD insurance under your own account (if applicable).

Special open enrollment

Certain events let you make account changes (like changing a health plan or enrolling a dependent) outside of annual open enrollment. We call these special open enrollment events.

You must provide proof of the event that created the special open enrollment (for example, a marriage or birth certificate) along with the Enrollment/Change form to your personnel, payroll, or benefits office no later than 60 days after the event.

These changes may be allowed as a special open enrollment:

If this event happens... Add dependent Remove dependent Change PEBB medical and/or dental plan Waive PEBB medical coverage Enroll after waiving PEBB medical coverage
Marriage, registering a state-registered domestic partner, as defined by Washington Administrative Code 182-12-109, birth, adoption, or assuming a legal obligation for total or partial support in anticipation of adoption. Yes1 Yes2 Yes Yes Yes
Child becomes eligible as an extended dependent through legal custody or legal guardianship. Also complete the PEBB Extended Dependent Certification and the PEBB Declaration of Tax Status form. Yes No Yes No Yes
Employee 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). Yes No Yes No Yes
Employee has a change in employment status that affects the employee's eligibility for their employer contribution toward their employer-based group health plan. Note: "Employer contribution" means contributions made by the dependent's current or former employer toward health coverage as described in Treasury Regulation 54.9801-6. Yes Yes Yes Yes Yes
Employee'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. Yes Yes Yes Yes Yes
Employee 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. Yes Yes No Yes Yes
Employee's dependent moves from outside the United States to live within the United States, or from within the United States to live outside of the United States and that change in residence resulted in the dependent losing their health insurance. Yes Yes No No Yes
Employee or dependent has a change in residence that affects health plan availability. No No Yes No No
A court order requires the employee or any other individual to provide a health plan for an eligible child of the employee. Yes Yes Yes No Yes
Employee or dependent becomes entitled to or loses eligibility for Medicaid or a state Children’s Health Insurance Program (CHIP). Yes Yes Yes Yes Yes
Employee or a dependent becomes eligible for a state premium assistance subsidy for PEBB health plan from Medicaid or a state CHIP. Yes No Yes No Yes
Employee or dependent becomes entitled to and enrolls in or loses eligibility for Medicare, or enrolls in or terminates enrollment in a Medicare Part D plan. Note: Waiving PEBB medical is only allowed if enrolling in Medicare. Enrolling after having waived PEBB medical is only allowed if lost eligibility for Medicare. No No Yes Yes Yes
Employee's or dependent’s current health plan becomes unavailable because the employee or dependent is no longer eligible for a health savings account (HSA). No No Yes No No
Employee 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). No No Yes, if approved by PEBB No No
Employee or dependent becomes eligible and enrolls in a TRICARE plan, or loses eligibility for a TRICARE plan. No No No Yes Yes

1Employee may add only the new spouse, state-registered domestic partner, or child(ren) of the spouse or partner. Existing dependents may not be added.

2Employee may only remove a dependent from PEBB coverage if the dependent enrolls in the new spouse’s or state-registered domestic partner’s plan.

For more details about the changes you can make during these events, see PEBB Program Administrative Policy Addendum 45-2A and refer to the following Washington Administrative Code (WAC) sections:

The PEBB Program's annual open enrollment

From November 1 through 30 each year, you can make changes to your PEBB account that will take effect January 1 of the following year.

During open enrollment you can:

  • Change medical or dental plans.
  • Enroll or remove eligible dependents.
  • Enroll in a medical plan, if you previously waived PEBB medical.
  • Waive enrollment in PEBB medical if you have or are enrolling in other employer-based group medical insurance, a TRICARE plan, or Medicare effective January 1. (Coverage through the Health Benefit Exchange is not group coverage.)
  • Enroll or reenroll in a Medical Flexible Spending Arrangement (PEBB benefits-eligible state agency and higher-education employees only).
  • Enroll or reenroll in the Dependent Care Assistance Program (PEBB benefits-eligible state agency and higher-education employees only).
  • Change your election under the state’s premium payment plan.
  • Reattest to the spouse or state-registered domestic partner coverage premium surcharge.

Changes you can make online

During the PEBB Program's annual open enrollment you can make changes online using PEBB My Account. Note: University of Washington employees must make changes through Workday.

You can:

  • Change your medical and/or dental plan(s).
  • Waive medical coverage if you are enrolled in other employer-based group medical insurance, a TRICARE plan, or Medicare (coverage through the Health Benefit Exchange is not group coverage).
  • Remove dependents from your coverage.
  • Reattest to the spouse or state-registered domestic partner coverage premium surcharge.

Please print or save your confirmation page when you’ve completed your changes. Check back in two business days to verify the coverage you selected and your spousal or state-registered domestic partner coverage premium surcharge attestation is correct.

When you submit an online plan change, please wait two business days to make any additional online plan changes.