Waiving medical coverage
You can waive PEBB medical coverage if you are enrolled in other employer-based group medical insurance, a TRICARE plan, or Medicare.
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To waive enrollment in medical, your employer must receive your completed Employee Enrollment/Change form indicating that you want to waive enrollment in medical no later than 31 days after the date you become eligible for PEBB benefits (this is generally the first day of employment), or during an annual or special open enrollment.
If your employer offers PEBB dental, basic life, and basic long-term disability insurance, you must enroll in these coverages for yourself (if eligible), regardless of whether you waive PEBB medical.
If you waive PEBB medical:
- You cannot enroll your eligible dependents in PEBB medical.
- The premium surcharges will not apply to you.
- You will not have access to SmartHealth and you will not be eligible for the $125 SmartHealth incentive.
If you are a newly eligible employee who is already enrolled in PEBB coverage as a dependent under your spouse’s, state-registered domestic partner’s, or parent’s account, you may either choose to:
- Waive PEBB medical, and stay enrolled in medical under your spouse’s, state-registered domestic partner’s, or parent’s account.
You must still enroll in PEBB dental, basic life, and basic long-term disability insurance (if your employer offers them) under your own account.
In addition, your spouse, state-registered domestic partner, or parent, must also complete and submit the Employee Enrollment/Change form form to remove you from their dental coverage to prevent dual enrollment in dental coverage.
- Enroll in PEBB medical under your own account.
In addition, your spouse, state-registered domestic partner, or parent will also need to complete and submit the appropriate enrollment/change form(s) to remove you from their account to prevent dual enrollment in PEBB health plan coverage.
Once you waive PEBB medical coverage, you may enroll during the PEBB Program's annual open enrollment (November 1 through 30) or if you have a qualifying special open enrollment event. Your personnel, payroll, or benefits office must receive your completed Employee Enrollment/Change form before the end of the annual open enrollment period (November 1 through 30) or no later than 60 days after a special open enrollment event. In many instances (outside of open enrollment), coverage will begin the first day of the month following the date of the event or the date your personnel, payroll, or benefits office receives your completed enrollment form and required documents, whichever is later. If that day is the first of the month, coverage will begin on that day. You may want to turn the form in sooner, so your benefits can begin and not be delayed. The PEBB Program will require you to provide proof of dependent eligibility for any enrolled dependents and proof of the event that created the special open enrollment. For more information, see WAC 182-12-128.
If your personnel, payroll, or benefits office does not receive a completed enrollment form indicating your intent to waive medical coverage no later than 31 days after you become eligible or regain eligibility for PEBB benefits, you will be enrolled as a single subscriber in Uniform Medical Plan (UMP) Classic, and Uniform Dental Plan (UDP), basic life insurance, and basic long-term disability (LTD) insurance (if your employer offers these coverages). If defaulted as a single subscriber, you will owe medical premiums back to your effective date for PEBB benefits. You will also be charged the $25 monthly tobacco use premium surcharge in addition to your monthly premiums. Your dependents (if any) will not be enrolled. If you were enrolled on your spouse's, state-registered domestic partner's, or your parent's PEBB coverage, you will be removed from that account due to the default.
For employees and their enrolled spouses ages 65 and older, you are not required to enroll in Medicare. If you are enrolled in Medicare Part A or B, you cannot enroll in a CDHP with an HSA. If employees and their enrolled spouses are enrolled in Medicare coverage (Part A or B, or both) and PEBB medical plans, PEBB medical plans provide primary coverage, and Medicare coverage is ordinarily secondary. However, you may choose to waive your enrollment in PEBB medical and have Medicare as your coverage. You will need to remain enrolled in PEBB dental, life, and long-term disability coverage.
If you waive PEBB medical, you can reenroll during the PEBB Program’s annual open enrollment (for coverage effective January 1 of the following year), or if you have a special enrollment event that allows the change.