Deferring coverage

What is deferring?

Deferring means postponing your PEBB health plan coverage in a way that lets you keep your eligibility to enroll at a later date. If you choose not to enroll at retirement or separation from state service, and you want to maintain your ability to enroll in a PEBB retiree health plan in the future, you must:

  • Defer (postpone or interrupt) your enrollment in PEBB retiree medical and dental coverage at or after retirement.
    AND
  • Be continuously enrolled in other medical coverage, as described in the eligibility section below.

If you defer enrollment in a PEBB retiree health plan, you may not enroll in a PEBB dental plan during your deferral period.

Except as stated in the  eligibility section below, if you defer enrollment in a PEBB retiree health plan, you also defer enrollment for your dependents.

Why would I defer?

You may want to defer if you have other medical coverage available. For example, if you are retiring but your spouse or state-registered domestic partner is still working, you may want to use their employer’s health coverage. Later, when your spouse or partner retires or separates from employment, you can apply to enroll yourself and any eligible dependents in PEBB retiree health plan coverage after your deferral. When you apply for enrollment after your deferral, you must provide proof of continuous enrollment in one or more qualifying medical coverages (including start and end dates).

Eligibility

You may defer enrollment in PEBB retiree benefits if:

  • You are continuously enrolled in a PEBB, or Washington State school district, or educational service district-sponsored medical plan as a dependent, including such coverage under continuation coverage.
  • Beginning January 1, 2001, if you are enrolled in employer-based group medical insurance as an employee or the dependent of an employee, or such medical insurance continued under continuation coverage. This does not include an employer’s retiree coverage.
  • Beginning January 1, 2001, if you are enrolled in medical coverage as a retiree or a dependent of a retiree in a TRICARE plan, CHAMPVA, or the Federal Employees Health Benefits Program. You will have a one-time opportunity to enroll in a PEBB retiree health plan.
  • Beginning January 1, 2006, if you are enrolled in Medicare Part A and Part B and a Medicaid program that provides creditable coverage. To be considered creditable coverage, your Medicaid coverage must include coverage for medical and hospital benefits. Your eligible dependents who are not eligible for creditable coverage under Medicaid may continue PEBB retiree health plan enrollment.
  • Beginning January 1, 2014, if you are not eligible for Medicare Part A and Part B you may defer enrollment in a PEBB retiree health plan if enrolled in qualified health plan coverage through a health benefit exchange established under the Affordable Care Act. This does not include Medicaid coverage, also known as Apple Health in Washington State. You will have a one-time opportunity to enroll in a PEBB retiree health plan. If you live in Washington State, you can find information about qualified health plans through the Washington State Health Benefit Exchange.The PEBB Program still must receive your Retiree Coverage Election Form (form A) within 60 days of your employer-paid coverage ending in order to defer your state retiree coverage.

  • Beginning July 17, 2018, if you are enrolled in medical coverage as a retiree or a dependent of a retiree in the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). You will have a one-time opportunity to enroll in a PEBB retiree health plan.

You must provide proof of continuous enrollment in one or more qualifying medical plan coverages to return to a PEBB retiree health plan after deferral. We encourage you to collect proof of coverage annually and keep a file to provide to the PEBB Program in the event you want to return in the future

How do I defer?

To defer enrollment in a PEBB health plan, retiring employees or enrolled retiree subscribers must submit the required forms to the PEBB Program within the required timeline requesting to defer.

  • If you are a retiring or eligible separating employee, the PEBB Program must receive the Retiree Coverage Election Form (form A) no later than 60 days after your employer-paid coverage, COBRA coverage, or continuation coverage ends. The PEBB Program will defer your enrollment the first of the month following the date your employer-paid coverage, COBRA coverage, or continuation coverage ends.
  • If you are an employee determined eligible for disability retirement, see “Can I enroll retroactively due to a disability” for additional information.
  • If you are an eligible elected state official or full-time appointed official of the legislative or executive branch of state government leaving public office, the PEBB Program must receive the Retiree Coverage Election Form (form A) no later than 60 days after the official leaves public office. The PEBB Program will defer your enrollment the first of the month following the date you leave public office.
  • If you are a retiree enrolled in PEBB retiree insurance coverage, the PEBB Program must receive the Retiree Coverage Election Change Form (form E) and any other required forms  before you defer coverage. Enrollment will be deferred effective the first of the month following the date the PEBB Program receives your form. If the form is received on the first day of the month, coverage will end on the last day of the previous month. Exception: If the PEBB Program received the forms on the first day of the month, enrollment will be deferred effective that day. When a member is enrolled in a Medicare Advantage Plan, enrollment in a PEBB retiree health plan will be deferred effective the first of the month following the date the Medicare Advantage Plan Disenrollment Form (form D) is received.
  • If you enrolled as a dependent in a medical plan sponsored by PEBB, a Washington State school district, educational service district, or charter school, or such coverage under  continuation coverage,  and then lose such coverage, you will have 60 days to enroll in a PEBB retiree health plan. To continue in a deferred status, the retiree must defer enrollment as described in WAC 182-12-205.
  • If you met eligibility requirements and your employer-paid coverage, COBRA coverage, or continuation coverage ended between January 1, 2001 and December 31, 2001, you were not required to submit a deferral form at that time. However, you must meet all other requirements.

Deferral rights for survivors of employees or retirees

A surviving spouse, state-registered domestic partner, or child who is eligible for PEBB retiree insurance coverage as a survivor under WAC 182-12-180 or 182-12-265 may defer enrollment under one of the circumstances listed below. If a survivor defers enrollment in PEBB retiree insurance coverage, they may not continue enrollment in a PEBB dental plan.

  • If a survivor is enrolled in a PEBB, Washington State school district, or educational service district-sponsored medical plan as a dependent, including such coverage under continuation coverage.
  • Beginning January 1, 2001, if a survivor is enrolled in employer-based group medical insurance as an employee or the dependent of an employee, or such medical insurance continued under or continuation coverage.
  • Beginning January 1, 2001, if a survivor is enrolled in medical coverage as a retiree or the dependent of a retiree in a TRICARE plan or the Federal Employees Health Benefits Program. These survivors will have a one-time opportunity to enroll in a PEBB retiree health plan.
  • Beginning January 1, 2006, if a survivor is enrolled in Medicare Part A and Part B and a Medicaid program that provides creditable coverage. To be considered creditable coverage, the survivor’s Medicaid coverage must include coverage for medical and hospital benefits. A survivor’s eligible dependent(s) who are not eligible for creditable coverage under Medicaid may continue PEBB retiree health plan enrollment.
    • Survivors not eligible for Medicare Part A and Part B may defer PEBB retiree insurance coverage if enrolled in qualified health plan coverage offered through a health benefits exchange established under the Affordable Care Act. This does not include Medicaid coverage, also known as Apple Health in Washington State. These survivors will have a one-time opportunity to enroll in a PEBB retiree health plan.
  • Beginning July 17, 2018, survivors who are enrolled in medical coverage as a retiree or a dependent of a retiree in the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). These survivors will have a one-time opportunity to enroll in a PEBB retiree health plan.

You must provide proof of continuous enrollment in one or more qualifying medical plan coverages to return to a PEBB retiree health plan after deferral. We encourage you to collect proof of coverage annually and keep a file to provide to the PEBB Program in the event you want to return in the future.

How to defer coverage for survivors of employees or retirees

To defer enrollment in PEBB retiree insurance coverage, a survivor must submit a Retiree Coverage Election Form (form A) to the PEBB Program:

  • In the event of an employee’s death, including elected or full-time appointed officials, the PEBB Program must receive the form no later than 60 days after the later of the date of the employee’s or official’s death or the date the survivor’s PEBB, school district, educational service district, or charter school coverage ends. Enrollment will be deferred effective the first of the month following the later of the date of the employee’s death or the date of the survivor’s PEBB, school district, educational service district, or charter school coverage ends.
  • In the event of a retiree’s death, the PEBB Program must receive the form no later than 60 days after the retiree’s death. Enrollment will be deferred effective the first of the month following the date of the retiree’s death.
  • If a survivor enrolls in PEBB retiree insurance coverage and is eligible to defer coverage in the future, the PEBB Program must receive the Retiree Coverage Election Change Form (form E) before the survivor defers coverage. Enrollment will be deferred effective the first of the month following the date the PEBB Program receives the form. For example, if the forms are received on the first day of the month, enrollment will be deferred effective that day. When a member is enrolled in a Medicare Advantage Plan, then PEBB retiree insurance coverage will be deferred effective the first of the month following the date the Medicare Advantage Plan Disenrollment Form (form D) is received.

Deferral rights for survivors of emergency services personnel

A surviving spouse, state-registered domestic partner, or dependent child of an emergency service personnel killed in the line of duty who is eligible for PEBB retiree insurance coverage under WAC 182-12-250 may defer enrollment under one of the circumstances listed below. If a survivor defers enrollment in PEBB retiree insurance coverage, they may not enroll in a PEBB dental plan.

  • If a survivor is enrolled in the PEBB, Washington State school district, or educational service district-sponsored medical plan as a dependent. Including such coverage under COBRA or continuation coverage.
  • Beginning January 1, 2001, if a survivor is enrolled in employer-based group medical insurance as an employee or the dependent of an employee, or such medical coverage continued under COBRA coverage or continuation coverage.
  • Beginning January 1, 2001, if a survivor is enrolled in medical coverage as a retiree or the dependent of a retiree in a TRICARE plan, CHAMPVA, or the Federal Employees Health Benefits Program. These survivors will have a one-time opportunity to enroll in a PEBB retiree health plan.
  • Beginning January 1, 2006, if a surviving dependent is continuously enrolled in Medicare Part A and Part B and a Medicaid program that provides creditable coverage. To be considered creditable coverage, the surviving dependent’s Medicaid coverage must include coverage for medical and hospital benefits. A survivor’s eligible dependent(s) who are not eligible for creditable coverage under Medicaid may continue PEBB retiree health plan enrollment.
  • Survivors who are not eligible for Medicare Part A and Part B may defer enrollment in PEBB retiree insurance coverage if enrolled in qualified health plan coverage offered through a health benefit exchange established under the Affordable Care Act. This does not include Medicaid coverage, also known as Apple Health in Washington State. These survivors will have a one-time opportunity to enroll in a PEBB retiree health plan.
  • Beginning July 17, 2018, survivors who are enrolled in medical coverage as a retiree or a dependent of a retiree in the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). These survivors will have a one-time opportunity to enroll in a PEBB retiree health plan.

You must provide proof of continuous enrollment in one or more qualifying medical plan coverages to return to a PEBB retiree health plan after deferral. We encourage you to collect proof of coverage annually and keep a file to provide to the PEBB Program in the event you want to return in the future.

How to defer coverage for survivors of emergency service personnel

To defer enrollment in PEBB retiree insurance coverage, a survivor must submit a Retiree Coverage Election Form (form A) to the PEBB Program. The PEBB Program must receive the form no later than 180 days after the later of:

  • The death of the emergency service worker.
  • The date on the eligibility letter from the Washington State Department of Retirement Systems or the board for volunteer firefighters and reserve officers.
  • The last day the survivor was covered under any health plan through the emergency service worker’s employer.
  • The last day the survivor was covered under COBRA coverage from the emergency service worker’s employer.

If a survivor enrolls in PEBB retiree insurance coverage and requests to defer coverage in the future, the PEBB Program must receive the Retiree Coverage Election Change Form (form E) and any other required form(s) before the survivor defers coverage. Enrollment will be deferred effective the first of the month following the date the PEBB Program receives the form(s).When a member is enrolled in a Medicare Advantage Plan, then PEBB retiree insurance coverage will be deferred effective the first of the month following the date the Medicare Advantage Plan Disenrollment Form (form D) is received.

How do I enroll after deferring PEBB coverage?

There are strict requirements for returning to PEBB retiree health plan coverage after deferring. Please read WAC 182-12-205 to learn more.

If a retiree or survivor deferred enrollment in PEBB retiree insurance coverage, they may enroll under the following circumstances, as long as they have had continuous enrollment in one or more qualifying coverages as required.

  • During any PEBB annual open enrollment. (November 1—30). The PEBB Program must receive the Retiree Coverage Election/Change (Open Enrollment) Form (form A-OE) and proof of continuous enrollment in one or more qualifying coverages no later than the last day of the PEBB Program’s open enrollment period.
  • When other qualified coverage ends. The PEBB Program must receive the Retiree Coverage Election Form (form A) no later than 60 days after the date other qualifying medical coverage ends. Enrollment will begin the first day of the month after other qualifying medical coverage ends. Although a retiree or survivor has 60 days to enroll, they must pay PEBB premiums and any applicable premium surcharges back to when other qualifying medical coverage ended. Proof of continuous enrollment in one or more qualifying medical coverages must list when the coverage began and ended.

A retiree or survivor has a one-time opportunity to enroll in PEBB medical and dental coverage if they deferred enrollment in PEBB retiree insurance coverage for a TRICARE plan, CHAMPVA, the Federal Employees Health Benefits Program, or coverage through a health benefit exchange established under the Affordable Care Act.

How do I enroll after deferring PEBB coverage for Medicaid?

Retirees or survivors who defer PEBB retiree insurance coverage while continually enrolled in Medicare Part A and Part B and a Medicaid program that provides creditable coverage may enroll in PEBB retiree insurance coverage during any PEBB Program annual open enrollment or if they lose their Medicaid coverage. The PEBB Program must receive the Retiree Coverage Election Form (form A) no later than 60 days after the date Medicaid coverage ends, or no later than the end of the calendar year when the retiree or survivor’s Medicaid coverage ends, if he or she was also eligible under subsidized Medicare Part D.

Retirees or survivors who defer enrollment may enroll in a PEBB retiree health plan if he or she receives formal notice that the Health Care Authority has determined it is more cost-effective to enroll the retiree or survivor (or their eligible dependent) in PEBB medical plan than a medical assistance program.

How do I cancel (terminate) coverage?

To cancel (terminate) all or part of your PEBB retiree insurance coverage, you must submit your request in writing. See cancel coverage for options for submitting your request to The PEBB Program.

Ending PEBB coverage

PEBB insurance covers an entire month and must end as follows:

  • When you or a dependent loses eligibility for PEBB retiree insurance coverage, coverage ends on the last day of the month in which eligibility ends.
  • Coverage for you and your enrolled dependents ends on the last day of the month for which the monthly premium and any applicable premium surcharges were paid. The PEBB Program charges an entire month’s premium for each calendar month of coverage. HCA will not prorate a premium if an enrollee dies or cancels their coverage before the end of the month.

To find out your options when coverage ends, see eligibility and enrollment information for PEBB Continuation Coverage subscribers.