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What is special open enrollment?
Certain life events let you change your benefits outside of annual open enrollment. For example, you move to a new county, get married, or have a child. We call these "special open enrollment" events.
Learn what events qualify for special open enrollment and the steps you need to take to change your benefits.
Deadline to submit forms and documentation: Your payroll or benefits office must receive your forms and proof of the event no later than 60 days after the event.
What changes can I make?
Based on the event, the following changes may be allowed as a special open enrollment. See the special open enrollment matrix for details.
My special open enrollment event is ...
As defined by Washington Administrative Code 182-12-260.
Action |
Allowed? |
---|---|
Add dependent |
Yes |
Remove dependent |
Yes |
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 |
Enroll after waiving PEBB medical coverage | Yes (Employee may enroll themself to enroll their new spouse and children. Existing noncovered dependents may not be enrolled.) |
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
Note: If the marriage or state-registered domestic partnership is within six months, only a marriage certificate or certificate of state-registered domestic partnership or legal union is required.
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 |
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, a signed PEBB Extended Dependent Certification and PEBB Declaration of Tax Status.
You or your 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
Your change in employment status affects your eligibility for your employer contribution toward your 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
The change 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
You or your 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 |
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
Your dependent’s change in residence results in the loss of 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)
You or your 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 you or your dependent to provide a health plan for an eligible child.
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
You or your dependent enrolls in or loses eligibility for 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 they lost eligibility for Medicaid or CHIP.
You or your 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.
You or your dependent enrolls in or loses eligibility for Medicare.
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, 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
Your or your dependent’s current health plan becomes unavailable because you or your 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
You or your dependent experience a disruption of care for active and ongoing treatment that could function as a reduction in benefits. Requires approval by the PEBB Program.
Action |
Allowed? |
---|---|
Add dependent |
No |
Remove dependent |
No |
Change PEBB medical/dental plan | Yes, if approved by the PEBB Program |
Waive PEBB medical coverage |
No |
Enroll after waiving PEBB medical coverage | No |
Documents to submit
- Employee Enrollment/Change form
- Letter or appeal explaining the situation and why you want or need the plan change.
Submit request for a plan change to:
Health Care Authority
PEBB Program
PO Box 42684
Olympia, WA 98504-5502
You or your 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
How do I make changes?
Submit the Employee Enrollment/Change form and your proof of the event (for example, a marriage or birth certificate) to your payroll or benefits office. Your payroll or benefits office must receive your forms and documentation no later than 60 days after the event.
See the special open enrollment matrix for a list of valid documents.
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.
When to submit when 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 payroll or benefits office 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.
Related laws and rules
For more details about the changes you can make during these events, see PEBB Program Administrative Policy Addendum 45-2A.
Contact
Your payroll or benefits office