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Dependent eligibility

Learn about eligibility requirements to enroll your dependents on your PEBB coverage.

Are my dependents eligible?

You may enroll the following dependents as described in WAC 182-12-260:

  • Your legal spouse
  • Your state-registered domestic partner as defined in WAC 182-12-109 and RCW 26.60.020(1).
    • This includes substantially equivalent legal unions from other jurisdictions as defined in RCW 26.60.090. Strict requirements apply to these partnerships, including that one partner is age 62 or older and you live in the same residence.
  • Your children (as defined in WAC 182-12-260(3)) through the last day of the month in which they turn age 26. Children with a disability may be covered past the age of 26 if they qualify (see below).

When you enroll eligible dependents on your PEBB health plan coverage, you may be required to provide proof of their eligibility with a document that shows they are your dependents. See Dependent verification for more information.

How are children defined?

Children are defined as described in WAC 182-12-260(3). This definition includes:

  • Children with whom you have a parent-child relationship as defined in RCW 26.26A.100 except when parental rights have been terminated. This includes your children, children of your spouse, children of your state-registered domestic partner.
  • Children you are legally required to support ahead of adoption.
  • Children specified in a court order or divorce decree for whom you are legally required to provide support or health care coverage.
  • Children with disabilities age 26 and older.
  • Extended dependent children who meet specified eligibility criteria.

Eligible extended dependents

Children may include extended dependents (such as a grandchild, niece, nephew, or other child) for whom you, your spouse or state-registered domestic partner are legal custodians or legal guardians. The legal responsibility is demonstrated by a valid court order and the child’s official residence with the custodian or guardian.

Extended dependent child does not include a foster child unless you, your spouse, or your state-registered domestic partner are legally required to provide support ahead of adoption.

How do I enroll an extended dependent?

To enroll an extended dependent, you must submit the appropriate enrollment/change form and the PEBB Extended Dependent Certification form along with a copy of your valid court order. If you are enrolling a nonqualified tax dependent, also submit the Declaration of Tax Status form.

Eligible children with a disability age 26 and older

Eligible children include children of any age with a developmental or physical disability that renders the child incapable of self-sustaining employment and chiefly dependent upon the subscriber for support and ongoing care, provided the condition occurred before the age of 26. You must provide proof of the disability and evidence the condition occurred before age 26 before their certification for enrollment can be approved.

How do I enroll my child with a disability?

You must provide evidence of the disability and evidence the condition occurred before age 26. The PEBB Program with input from the medical plan (if applicable), will periodically verify the eligibility of a dependent child with a disability beginning at age 26, but no more frequently than annually after the two-year period following the child's 26th birthday. Verification will require renewed proof of disability and dependence from you.

If the PEBB Program does not receive your recertification form within the time allowed, the child will no longer be covered, and you will not be able to add the child back onto your coverage until you experience a special open enrollment event or during the next annual open enrollment period. See Change your coverage for employees, retirees, and PEBB Continuation Coverage.

A child with a disability who becomes self-supporting is not eligible as of the last day of the month in which they become capable of self-support. If the child becomes capable of self-support and later becomes incapable of self-support, the child does not regain eligibility as a child with a disability.

You must notify the PEBB Program in writing when your child with a disability is no longer eligible. The PEBB Program must receive notice within 60 days of the last day of the month your child loses eligibility for PEBB health plan coverage. 

In addition to dependent verification documents (if required), also submit the appropriate enrollment/change form and the PEBB Certification of a Child with a Disability form

Surviving dependents eligibility

If you die, your dependents (a spouse, state-registered domestic partner, or dependent child) will lose their eligibility toward PEBB benefits. They may be eligible to enroll or defer enrollment in PEBB retiree insurance coverage as your survivor, instead of enrolling in PEBB Continuation Coverage. If eligible, your surviving spouse or state-registered domestic partner has PEBB retiree insurance coverage available for life and it is available for your surviving children up to the limiting age for child eligibility.