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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.

How do I waive coverage?

To waive enrollment in medical, your employer must receive the appropriate PEBB 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 open enrollment or special open enrollment.

If your employer offers PEBB dental, basic life insurance, basic AD&D insurance, and basic long-term disability insurance, you must enroll in these coverages for yourself, regardless of whether you waive PEBB medical.

If you waive enrollment in medical coverage:

  • You cannot enroll your eligible dependents in PEBB medical, but you can enroll them in PEBB dental coverage if your employer offers it.
  • The premium surcharges will not apply to you.
  • You are eligible to participate in the SmartHealth wellness program, but you cannot qualify for the wellness incentives.
  • You can enroll in supplemental life insurance, supplemental AD&D insurance, supplemental LTD insurance, the Medical Flexible Spending Arrangement (FSA), and Dependent Care Assistance Program (DCAP), if your employer offers them.

What if I’m already enrolled in PEBB health plan coverage?

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 insurance, basic AD&D insurance, 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 submit the appropriate PEBB Employee Enrollment/Change form to remove you from their dental coverage to prevent dual enrollment in dental coverage.

    OR

  • Enroll in PEBB medical under your own account.
    In addition, your spouse, state-registered domestic partner, or parent will also need to submit the appropriate enrollment/change forms to remove you from their account to prevent dual enrollment in PEBB health plan coverage.

How do I enroll after waiving coverage?

Once you waive enrollment in PEBB medical coverage, you may enroll during the PEBB Program's annual open enrollment or if you have an event that creates a special open enrollment event. Your payroll or benefits office must receive the appropriate PEBB Employee Enrollment/Change form before the end of the annual open enrollment  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 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 eligibility for any dependents you want to enroll and proof of the event that created the special open enrollment. For more information, see WAC 182-12-128.

What if I don’t submit an enrollment form to waive PEBB medical coverage?

If your 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 automatically enrolled as a single subscriber in Uniform Medical Plan (UMP) ClassicUniform Dental Plan (UDP), basic life insurance, basic accidental death and dismemberment (AD&D) insurance, and basic long-term disability (LTD) insurance (if your employer offers these coverages). A $25 tobacco use premium surcharge will apply. If automatically enrolled as a single subscriber, you will owe UMP Classic medical premiums and the tobacco use premium surcharge back to your effective date for PEBB benefits. Your dependents (if any) will not be enrolled. If you are enrolled on your spouse's, state-registered domestic partner's, or your parent's PEBB coverage, you will be removed from that coverage.

What if I’m entitled to Medicare?

For employees and their enrolled dependents age 65 and older, enrollment in Medicare is not required. If you are enrolled in Medicare Part A or Part B, you cannot enroll in a CDHP with an HSA. If employees and their enrolled dependents are enrolled in Medicare coverage (Part A or Part B, or both) and a PEBB medical plan, in most cases, the PEBB medical plans provide primary coverage, and Medicare coverage is ordinarily secondary. There are circumstances where Medicare would be the primary payer even when you or a covered dependent are enrolled in employer-sponsored benefits. Contact your PEBB medical plan for more information. You may choose to waive your enrollment in PEBB medical and have Medicare as your  primary coverage. You will need to remain enrolled in PEBB dental, basic life, basic AD&D, and long-term disability insurance.

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 open enrollment event that allows the change.