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 ...
- 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
- 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 or their dependent's eligibility for their 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?
Contact
Your payroll or benefits office