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How to determine eligibility

Find out if you are eligible for PEBB benefits.

On April 2, 2020, the Public Employees Benefits Board (PEB Board) held a special telephonic meeting to approve 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. Learn more about the approved emergency resolution.

Am I eligible?

Your employer will determine if you are eligible for PEBB benefits based on your specific employment circumstances, and whether you qualify for the employer contribution (see WAC 182-12-114 and 182-12-131). If you disagree with the determination, see File an appeal.

If you are an employee from an employer group that received 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 for eligibility criteria.

You are eligible for PEBB benefits upon employment if your employer anticipates you will work an average of at least 80 hours per month and for at least eight hours in each month for more than six consecutive months.

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.

If your employer determines you are not eligible, but 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.

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. See WAC 182-12-114(1)(c)

“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.

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.

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.

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). See WAC 182-12-142. The PEBB Program must receive your election to self-pay benefits no later than 60 days from the date the PEBB health plan coverage ended or from the postmark date on the election notice sent by the PEBB Program, whichever is later. See PEBB Continuation Coverage How to determine eligibility 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 and work for at least eight hours each month of 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.

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.

If you work in more than one position within one state agency, you may stack or combine hours to establish and maintain eligibility. See WAC 182-12-114(2)(C) for details. 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.

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, but 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. See WAC 182-12-142. The PEBB Program must receive your election to self-pay benefits no later than 60 days from the date PEBB health plan coverage ended or from the postmark date on the election notice sent by the PEBB Program, whichever is later. See PEBB Continuation Coverage How to determine eligibility 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.

You cannot enroll in medical or dental coverage under two PEBB accounts. If you are eligible as an employee and as a dependent under your spouse’s, state-registered domestic partner’s or parent’s account, see Waiving medical coverage for options available to you.

Effective January 1, 2022, if you are eligible to enroll in both the PEBB and School Employees Benefits Board (SEBB) Programs, you are limited to a single enrollment in medical and dental (PEBB Program) or medical, dental, and vision (SEBB Program). If you do not take action to resolve the dual enrollment, the SEBB Program or PEBB Program will automatically enroll or disenroll you as described in WAC 182-12-123(6). You cannot enroll in both PEBB and SEBB health plans.

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 (see definition in WAC 182-12-109 and RCW 26.60.020(1)). This includes substantially equivalent legal unions from other jurisdictions (see definition 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 (see definition 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 are required to provide poof of their eligibility with a document that shows they are your dependents.

Learn more about dependent eligibility.

Surviving dependents eligibility

If you die, your dependents (a spouse, state-registered domestic partner, or dependent child) will lose their eligibility for the employer contribution 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. Learn more about survivors.

Contact

Your payroll or benefits office