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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 forms to your 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.

What changes can I make during open enrollment?

Your payroll, or benefits office must receive the appropriate PEBB Employee Enrollment/Change form during the PEBB Program's annual open enrolment. You may also make some changes using PEBB My Account. The enrollment change will become effective 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 using PEBB My Account during open enrollment

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 plans.
  • 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.

What changes can I 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.

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).

What is a special open enrollment?

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.

What changes can I make during a 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 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 Submit these documents (list is not inclusive)
Marriage, registering a domestic partnership, as defined by Washington Administrative Code 182-12-109.  Yes1 Yes2 Yes Yes3 Yes

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. Yes Yes  Yes Yes3 Yes

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.  Yes No Yes No Yes

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.

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

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

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

Employee hire letter from employer that contains information about benefits eligibility; employment contract; termination letter; letter of resignation; statement of insurance; certificate of coverage

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.

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 hire letter from their employer that contains information about benefits eligibility; employment contract; termination letter; letter of resignation; statement of insurance; certificate of coverage.
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 Yes3 Yes

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

Employee'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. Yes Yes No No Yes 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).
Employee or dependent has a change in residence that affects health plan availability. No No Yes No No Proof of former and current residence (e.g. utility bill); certificate of credible coverage.
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 Valid court order.
Employee or dependent enrolls in or loses eligibility for Apple Health (Medicaid) or a state Children’s Health Insurance Program (CHIP). Yes Yes Yes No Yes

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

Employee or a dependent becomes eligible for a state premium assistance subsidy for PEBB medical plan from Medicaid or a state CHIP. Yes No Yes No Yes

Eligibility letter from Medicaid or CHIP

Employee or dependent enrolls in or loses eligibility for Medicare. If enrolling after waiving PEBB medical, only allowed if lost eligibility for Medicare No No Yes Yes Yes

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.

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

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

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

Submit request for a plan change to:
Health Care Authority
PEBB Program
PO Box 42684
Olympia, WA 98504-5502

Employee or dependent becomes eligible and enrolls in a TRICARE plan, or loses eligibility for a TRICARE plan. No No No Yes Yes Certificate of credible coverage; proof of enrollment or termination of coverage from TRICARE.

1Employee may add only the new spouse, state-registered domestic partner, or children 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.

3Waiving for this event is allowed only if the employee enrolls in medical under the new spouse or state-registered domestic partner's employer-based group health 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: