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Special open enrollment

What is a special open enrollment?

Certain events let you make changes to your benefits outside of annual open enrollment. (For example, change your health plan or enroll a dependent.)

We call these "special open enrollment" events. 

To take advantage of special open enrollments, your payroll or benefits office must receive your proof of the event along with the appropriate PEBB Employee Enrollment/Change form no later than 60 days after the event. (See PEBB Program Administrative Policy Addendum 45-2A for a list of valid documents.)

Things to know

  • When to submit. You may want to submit your request sooner to avoid a delay in the enrollment or change, and to ensure timely payment of claims.
  • Adding a child. When the special open enrollment is for birth, adoption, or assuming legal obligation for support ahead of adoption, submit the required forms and proof of your dependent’s eligibility and the event as soon as possible. If adding the child increases the premium, your employer must receive the required forms and proof no later than 60 days after the date of the birth, adoption, or when you assumed legal obligation.

What changes can I make during a special open enrollment?

The following changes may be allowed as a special open enrollment. See PEBB Program Administrative Policy Addendum 45-2A for more details about the changes you can make. 

My special open enrollment event is ...

As defined by Washington Administrative Code 182-12-260.

Action

Allowed?

Add dependent

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

Remove dependent

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

Change PEBB medical/dental plan Yes
(A health plan change is not allowed when adding a SRDP or their child if they are not a tax dependent.)
Waive PEBB medical coverage

Yes
(Waiving 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.)

Enroll after waiving PEBB medical coverage Yes

Documents to submit 

  • 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. 

Action

Allowed?

Add dependent

Yes

Remove dependent

Yes

Change PEBB medical/dental plan Yes
Waive PEBB medical coverage

Yes
(Waiving 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.)

Enroll after waiving PEBB medical coverage Yes

Documents to submit

  • 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. 

Action

Allowed?

Add dependent

Yes

Remove dependent

No

Change PEBB medical/dental plan Yes
Waive PEBB medical coverage

No

Enroll after waiving PEBB medical coverage Yes

Documents to submit 

  • 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).

Action

Allowed?

Add dependent

Yes

Remove dependent

No

Change PEBB medical/dental plan Yes
Waive PEBB medical coverage

No

Enroll after waiving PEBB medical coverage Yes

Documents to submit 

  • Certificate of creditable coverage.
  • Letter of termination of coverage from health plan or payroll or benefits office.
  • 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. 

Action

Allowed?

Add dependent

Yes

Remove dependent

Yes

Change PEBB medical/dental plan Yes
Waive PEBB medical coverage

Yes

Enroll after waiving PEBB medical coverage Yes

 Documents to submit 

  • 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.

Action

Allowed?

Add dependent

Yes

Remove dependent

Yes

Change PEBB medical/dental plan Yes
Waive PEBB medical coverage

Yes

Enroll after waiving PEBB medical coverage Yes

 Documents to submit 

  • 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.

Action

Allowed?

Add dependent

Yes

Remove dependent

Yes

Change PEBB medical/dental plan No
Waive PEBB medical coverage

Yes
(Waiving 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.)

Enroll after waiving PEBB medical coverage Yes

Documents to submit 

  • 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.

Action

Allowed?

Add dependent

Yes

Remove dependent

Yes

Change PEBB medical/dental plan No
Waive PEBB medical coverage

No

Enroll after waiving PEBB medical coverage Yes

 Documents to submit

  • 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.

Action

Allowed?

Add dependent

No

Remove dependent

No

Change PEBB medical/dental plan Yes
Waive PEBB medical coverage

No

Enroll after waiving PEBB medical coverage No

Documents to submit 

  • 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.

Action

Allowed?

Add dependent

Yes

Remove dependent

Yes

Change PEBB medical/dental plan Yes
Waive PEBB medical coverage

No

Enroll after waiving PEBB medical coverage Yes

Documents to submit 

  •  Valid court order.

Employee or dependent enrolls in or loses eligibility for Apple Health (Medicaid) or a state Children’s Health Insurance Program (CHIP). 

Action

Allowed?

Add dependent

Yes

Remove dependent

Yes

Change PEBB medical/dental plan Yes
Waive PEBB medical coverage

No

Enroll after waiving PEBB medical coverage Yes

Documents to submit 

  • 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.

Action

Allowed?

Add dependent

Yes

Remove dependent

No

Change PEBB medical/dental plan Yes
Waive PEBB medical coverage No
Enroll after waiving PEBB medical coverage Yes

 Documents to submit 

  • Eligibility letter from Medicaid or CHIP.

Employee or dependent enrolls in or loses eligibility for Medicare. 

Action

Allowed?

Add dependent

Yes
(The subscriber may enroll a dependent who lost eligibility for coverage under Medicare. Existing noncovered dependents who did not lost Medicare eligibility may not be enrolled.)

Remove dependent

Yes
(A health plan change is not allowed when adding a SRDP or their child if they are not a tax dependent.) 

Change PEBB medical/dental plan Yes
Waive PEBB medical coverage

Yes

Enroll after waiving PEBB medical coverage Yes, only allowed if lost eligibility for Medicare 

 Documents to submit 

  • 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). 

Action

Allowed?

Add dependent

No

Remove dependent

No

Change PEBB medical/dental plan Yes
Waive PEBB medical coverage

No

Enroll after waiving PEBB medical coverage No

Documents to submit 

  • 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). 

Action

Allowed?

Add dependent

No

Remove dependent

No

Change PEBB medical/dental plan Yes, if approved by PEBB
Waive PEBB medical coverage

No

Enroll after waiving PEBB medical coverage No

Documents to submit 

  • 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.

Action

Allowed?

Add dependent

No

Remove dependent

No

Change PEBB medical/dental plan No
Waive PEBB medical coverage

Yes

Enroll after waiving PEBB medical coverage Yes

Documents to submit 

  • Certificate of credible coverage
  • Proof of enrollment or termination of coverage from TRICARE.

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: