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How to enroll

Find the required forms and timelines to enroll in PEBB benefits.

What forms do I use?

Note: Pierce County, Washington State University, and University of Washington employees must enroll through Workday.

Submit your forms to your payroll or benefits office no later than 31 days after you become eligible for PEBB benefits.

If your payroll or benefits office, or MetLife in the case of life insurance, doesn’t receive your completed forms and dependent verification documents (if applicable) within the timelines, you will be enrolled as a single subscriber in Uniform Medical Plan (UMP) Classic, and (if your employer offers these coverages) Uniform Dental Plan (UDP), basic life insurance, basic AD&D insurance, and employer-paid long-term disability (LTD) insurance. You will also be automatically enrolled in employee-paid LTD insurance, unless you decline the coverage. Your dependents will not be enrolled and you will be charged a tobacco use premium surcharge. You cannot change plans or enroll eligible dependents until the next annual open enrollment, unless you have a special open enrollment event that allows the change.

Submit the Employee Enrollment/Change form (if your employer offers the full benefits package) or the Employee Enrollment/Change for Medical Only Groups form (if your employer offers PEBB medical coverage only) to your payroll or benefits office no later than 31 days after you become eligible for benefits.

The following form must be received by MetLife no later than 31 days after you become eligible for PEBB benefits:

  • PEBB MetLife Enrollment/Change form. If you have questions about enrollment in life insurance, contact MetLife at 1-866-548-7139. Evidence of insurability is not required within the 31-day window.

Note: You may choose to enroll in supplemental life insurance and accidental death and dismemberment (AD&D) insurance at any time during the calendar year by submitting the required forms to MetLife. If you apply after your 31-day eligibility period or outside of a special open enrollment event, MetLife must approve your request and evidence of insurability will be required.

To enroll in supplemental (employee-paid) LTD insurance through December 31, 2021: Submit the PEBB Long-Term Disability Enrollment/Change form to your payroll or benefits office no later than 31 days after you become eligible for PEBB benefits.

Starting January 1, 2022, all employees will be automatically enrolled in an employee-paid long-term disability (LTD) plan that covers 60 percent of your insured income (up to $16,667) with a 90-day benefit waiting period.

At any time, use the Long-Term Disability Enrollment/Change form to reduce to a lower-cost 50-percent coverage level or decline the coverage. Note: Pierce County, UW, and WSU employees, use Workday to reduce or decline coverage.

If you later decide to enroll in or increase coverage, you will have to provide evidence of insurability and be approved by the insurer. Visit Long-term disability insurance for more information.

To enroll in a Medical Flexible Spending Arrangement (FSA), Limited Purpose FSA, or DCAP (state agency and higher-education employees only): Visit the Navia Benefit Solutions website to enroll no later than 31 days after you become eligible for PEBB benefits.

Am I required to enroll?

If your employer determines that you are eligible, you are required to enroll. However, you may waive your enrollment in medical coverage if you are enrolled in another employer-based group medical, a TRICARE plan, or Medicare. If you waive, your dependents will not be enrolled.

If you waive enrollment in PEBB medical, you will still be enrolled in PEBB dental. Exception: You may waive enrollment in PEBB medical to enroll in School Employees Benefits Board (SEBB) medical only if you are also enrolled in SEBB dental and vision. By doing so, you waive enrollment in PEBB dental.

What if I don't enroll?

If you are eligible but do not enroll or waive enrollment, you will be enrolled as a single subscriber in Uniform Medical Plan (UMP) Classic, and (if your employer offers these coverages) Uniform Dental Plan (UDP), basic life insurance, basic AD&D insurance, and employer-paid long-term disability (LTD) insurance. You will also be automatically enrolled in employee-paid LTD insurance, unless you decline the coverage. Your dependents will not be enrolled. You will be charged a tobacco use premium surcharge. You will be charged a monthly premium for medical coverage, as well as a $25 tobacco use premium surcharge. You cannot change plans or enroll eligible dependents until the next open enrollment, unless you have a special open enrollment event that allows the change.

How do I enroll my dependents?

If you enroll dependents on your PEBB coverage, you must provide proof of their eligibility within the required enrollment timelines or the dependents will not be enrolled. See Dependent verification.

Additional required forms for dependents

You may also need these forms:

What If I’m eligible for benefits as an employee and a dependent?

Medical and dental coverage is limited to a single enrollment per individual. If you are an eligible employee and are also eligible as a dependent under your spouse’s, state-registered domestic partner’s, or parent’s account, you may choose one of these options:

  • Waive your enrollment in PEBB medical under your own account and, instead, stay enrolled in PEBB medical under your spouse’s, state-registered domestic partner’s, or parent’s PEBB account. You must still enroll in dental, vision, basic life insurance, basic AD&D insurance, and employer-paid LTD insurance under your own account. You will also be enrolled in employee-paid LTD insurance, unless you decline the coverage.
  • Enroll in medical (as well as dental, vision, basic life insurance, basic AD&D insurance, and employer-paid LTD insurance) under your own account. You will also be enrolled in employee-paid LTD insurance, unless you decline the coverage. You must be removed from the other medical, dental, and vision accounts.

Can I enroll in both PEBB and SEBB coverage?

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

What if I'm enrolled in Medicare?

If you or any of your dependents are enrolled in Medicare, or may soon be, learn more about how Medicare and PEBB benefits work together while you're employed.

FAQs

How do I waive coverage?

You may waive enrollment in PEBB medical if you are enrolled in other employer-based group medical, a TRICARE plan, or Medicare. You must submit a form to waive enrollment in PEBB medical. If you waive coverage for yourself, you cannot enroll your eligible dependents in PEBB medical. See Waiving medical coverage.

When does coverage start?

If you're newly eligible

Medical, dental, basic life, basic AD&D insurance, and employer-paid LTD insurance coverage begins on the first day of the month following the date you become eligible for PEBB benefits (generally the first day of employment). If you become eligible on the first working day of the month, benefits begin on that day.

If you're a faculty member hired on a quarter/semester to quarter/semester basis

Medical, dental, basic life, basic AD&D insurance, and employer-paid LTD insurance begins on the first of the month following the beginning of the second consecutive quarter/semester of half-time or more employment (or anticipated half-time or more employment). If the first day of the second consecutive quarter/semester is the first working day of the month, benefits begin at the beginning of the second consecutive quarter/semester.

How do I get my plan ID cards?

After you enroll, your health plans will send you an identification (ID) card to show providers when you receive care. If you have questions about your ID card, contact your plan directly. The Uniform Dental Plan does not mail ID cards, but you may download one from the plan’s website.

What if I want to change my coverage later?

You can change plans or make enrollment changes at the next annual open enrollment or if you have a special open enrollment event that allows the change.

Contact

Your payroll or benefits office