What is special open enrollment?

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 ...

Marriage or registering a domestic partnership

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 noncovered 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  (Employee may enroll themselves 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 or adoption

Birth, adoption, or assuming a legal obligation for support in anticipation of adoption. 

Action	Allowed?
Add dependent	Yes (Employee may also enroll a spouse or state-registered domestic partner but may not enroll existing noncovered dependent children.)
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 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.

Newly eligible extended dependent

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.

Loss of other coverage

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

You have a change in employment status

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 (Waiving for this event is allowed only if you enroll in medical under your spouse or SRDP's employer-based group health plan.)
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

Your dependent has a change in their own employment status

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 (Waiving for this event is allowed only if you enroll in medical under your spouse or SRDP's employer-based group health plan)
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

Change under other employer-based group health plan's open enrollment

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 (Waiving for this event is allowed only if the employee enrolls in medical under the 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

Your dependent moves from another country to the U.S. or from the U.S. to another country

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)

Change in residence

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

Court order

 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

Gain or lose eligibility for Medicaid or CHIP

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.

Become eligible for state premium assistance subsidy for PEBB medical plan coverage from 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.

Gain or lose eligibility for Medicare

You or your dependent enrolls in or loses eligibility for Medicare. 

Action	Allowed?
Add dependent	Yes (You 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

Medical plan becomes unavailable

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

Continuity of care

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

Gain or lose eligibility for TRICARE

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.

For current subscribers

• WAC 182-08-198:  When may a subscriber change health plans?
• WAC 182-12-262:  When may subscribers enroll or remove eligible dependents?

For employees

• WAC 182-08-199:  When may an employee enroll in or revoke an election and make a new election under the premium payment plan, Medical Flexible Spending Arrangement (FSA) or Dependent Care Assistance Program (DCAP)?
• WAC 182-12-128:  When may an employee waive enrollment in PEBB medical, and when may they enroll in PEBB medical after waiving enrollment?