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Deferring coverage

What is deferring?

Deferring means postponing your PEBB retiree insurance coverage in a way that lets you keep your eligibility to enroll at a later date. To defer enrollment, you must meet the eligibility and procedural requirements under PEBB Program rules for PEBB retiree insurance coverage and be enrolled in other qualified medical coverage. You may choose to defer your enrollment when you first become eligible for PEBB retiree insurance coverage or after you enroll. To defer your enrollment, you must: 

  • Defer (postpone) your enrollment in PEBB retiree medical and dental coverage by submitting the required forms to the PEBB Program.
    AND
  • Be continuously enrolled in other qualified medical coverage, as described in the eligibility section below.

If you defer enrollment, enrollment in PEBB medical and PEBB dental is deferred. A subscriber must be enrolled in PEBB medical to enroll in PEBB dental. 

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

Why would I defer?

You may want to defer if you have other qualified 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 a PEBB retiree health plan ending 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

If you are eligible for PEBB retiree insurance coverage under WAC 182-12-171, 182-12-180, or 182-12-211, you may defer enrollment in PEBB retiree insurance coverage if: 

  • If you are enrolled in a Washington State educational service district-sponsored, PEBB-sponsored, or SEBB-sponsored medical plan as a dependent, including COBRA or continuation coverage.
  • Beginning July 17, 2018, if you are enrolled 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.
  • Beginning January 1, 2014, if you are not eligible for Medicare Part A and Part B and you are 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 or reenroll 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.
  • 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 stay enrolled in a PEBB retiree health plan.
  • Beginning January 1, 2001, if you are enrolled in medical coverage as a retiree or a dependent of a retiree in a TRICARE plan, 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, 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 COBRA or continuation coverage. This does not include an employer’s retiree coverage.

You must provide proof of continuous enrollment in one or more qualifying medical plan coverages to return to a PEBB retiree health plan after a 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.

Required timelines for retirees to defer

To defer enrollment in PEBB retiree insurance coverage, you must submit the required forms to the PEBB Program.

  • If you are an eligible retiring employee (or in some cases, a separating employee), or school employee, the PEBB Program must receive the Retiree 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 after the date your employer-paid coverage, COBRA coverage, or continuation coverage ends.
  • If you are an employee or school employee determined eligible for disability retirement, see “Can I enroll retroactively due to a disability” for additional information.
  • If you are an eligible elected or full-time appointed official leaving public office, the PEBB Program must receive the Retiree Election Form (form A) no later than 60 days after you leave office. We will defer your enrollment the first of the month after the date you leave office.
  • If you are a retiree enrolled in PEBB retiree insurance coverage, the PEBB Program must receive the Retiree Election Change Form (form E) and any other required forms  before you defer coverage. Enrollment will be deferred effective the first day of the month after the date we receive all the required forms. We receive 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 will be deferred effective the first of the month after the date we receive the Medicare Advantage Plan Disenrollment Form (form D).
  • If you enrolled as a dependent in a Washington State educational service district-sponsored, PEBB-sponsored, or SEBB-sponsored medical plan (including COBRA or continuation coverage), and then lose 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 procedural 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 enroll in or continue enrollment in a PEBB dental plan.

  • If a survivor is enrolled in a PEBB, a Washington State educational service district, or SEBB 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 insurance continued under COBRA 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.
  • Beginning January 1, 2014, survivors 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 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 or reenroll in a PEBB retiree health plan.
  • Beginning July 17, 2018, survivors who are enrolled 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, except as stated below, a survivor must submit a Retiree Election Form (form A) to the PEBB Program:

  • In the event of an employee’s death, the PEBB Program must receive the form no later than 60 days after the date of the employee’s death or the date the survivor’s PEBB, educational service district, or SEBB insurance coverage ends, whichever is later.
  • In the event of an elected or full-time appointed official’s death, the PEBB Program must receive the form no later than 60 days after the date of the official’s death, or the date the survivor’s PEBB insurance coverage ends, whichever is later.
  • 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.
  • If a survivor enrolls in PEBB retiree insurance coverage and becomes eligible to defer coverage, the PEBB Program must receive the Retiree Election Change Form (form E) and any other required forms. Enrollment will be deferred effective the first of the month after the date the PEBB Program receives the forms. 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 coverage will be deferred effective the first of the month after the date we receive the Medicare Advantage Plan Disenrollment Form (form D).

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 or continue enrollment in a PEBB dental plan.

  • If a survivor is enrolled in the PEBB, a Washington State educational service district, or SEBB 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, 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 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.
  • Beginning January 1, 2014, survivors who are not eligible for Medicare Part A and Part B may defer enrollment in PEBB retiree insurance coverage if they are 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 or reenroll in a PEBB retiree health plan.
  • Beginning July 17, 2018, survivors who are enrolled 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 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 (including COBRA coverage) through 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 Election Change Form (form E) and any other required form(s) before the survivor's coverage will be deferred. Enrollment will be deferred effective the first of the month following the date the PEBB Program receives the form(s). If the forms are received on the first day of the month, enrollment will be deferred 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.

How do I enroll after deferring PEBB retiree insurance coverage?

There are strict requirements for returning to a PEBB retiree health plan 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 in a PEBB retiree health plan under the following circumstances, as long as they have had continuous enrollment in one or more qualifying coverages as required.

  • During any PEBB Program annual open enrollment. The PEBB Program must receive the Retiree Open Enrollment Election/Change Form (form A-OE) and proof of continuous enrollment in one or more qualifying coverages no later than the last day of open enrollment. Your enrollment will begin January 1 of next year.
  • When other qualified medical coverage ends. The PEBB Program must receive the Retiree Election Form (form A) no later than 60 days after the date your other qualifying medical coverage ends. Enrollment will begin the first day of the month after the other qualifying medical coverage ends. Although you have 60 days to enroll, you must pay premiums and applicable premium surcharges back to when your other qualifying medical coverage ended. Proof of continuous enrollment in one or more qualifying medical coverages must list the dates the coverage began and ended. Exception: If you select a Medicare Advantage or Medicare Advantage Prescription Drug (MAPD) plan, we must receive your form not later than the last day of the month before the month your other qualifying medical coverage ends. Otherwise, you may not select a Medicare Advantage or MAPD plan until a special open enrollment.

You have a one-time opportunity to enroll in a PEBB retiree health plan if you 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 retiree insurance coverage for Medicare and Medicaid?

If you deferred while enrolled in Medicare Part A and Part B and a Medicaid program that provides creditable coverage, you may enroll in a PEBB retiree health plan no later than the end of the calendar year in which your Medicaid coverage ends. See WAC 182-12-305 (6) (c) (iii) to learn more.

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 retiree insurance coverage

PEBB retiree insurance coverage is for 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 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 requests to cancel their coverage before the end of the month.
  • Coverage for you or an enrolled dependent ends if you fail to respond to a request from the PEBB Program for information regarding Medicare Part A and Part B enrollment or an action required due to enrollment in Medicare Part D.

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