Denied coverage? You may still be eligible.

Am I eligible?

You may reapply for coverage if you meet all of the following.

• You are receiving a retirement allowance under the Teachers’ Retirement System (TRS), School Employees’ Retirement System (SERS), Public Safety Employees’ Retirement System (PSERS), or the Public Employees’ Retirement System (PERS).
• You have been denied health care coverage solely for failure to timely notify HCA of your plan to defer coverage.
• You have appealed the denial of benefits to HCA on or before December 31, 2022.
• You are Medicare eligible.

Things you must do and their deadlines

What do I need to do?

Submit the following materials to the PEBB Program:

• Retiree Election Form (form A).
• Any other required forms or documents, based on your situation.
• Your first premium payment.

By when?

Forms and documentation: No later than November 30, 2023 (the last day of annual open enrollment).

First premium payment: No later than 45 days after your coverage begins. See Paying for benefits for details.

Where do I submit my materials?

Forms and documentation

Submit your forms using one of the following methods.

Electronically

Submit your forms through HCA Support. Attach them to a secure message. Be sure to sign them (typed signatures are not allowed).

Note: To keep your personal information secure, you will need to register for a SecureAccess Washington (SAW) account (if you don't already have one) to submit your materials using this method.

Fax

360-725-0771

Mail forms without payment

Washington State Health Care Authority
PEBB Program
PO Box 42684
Olympia, WA 98504-2684

Mail forms with first payment and premium surcharges

If you're sending payment with your forms, enclose your check or money order payable to Health Care Authority and mail to:

Washington State Health Care Authority
PO Box 42691
Olympia, WA 98504-2691

When does coverage begin?

Coverage is effective the first day of the month following the date you signed the Retiree Election Form (form A). If the signature date is the first day of the month, coverage will be effective the first day of the following month.

What are my medical plan options?

You may enroll only in the following Medicare Advantage or Medicare Supplement medical plans:

• Kaiser Permanente NW Senior Advantage
• Kaiser Permanente WA Medicare Advantage
• Premera Blue Cross Medicare Supplement Plan G
• UnitedHealthcare PEBB Balance or PEBB Complete

You and your dependents cannot enroll in dental only coverage.

FAQs

Can I enroll in other PEBB benefits because of this bill?

No. If you meet the eligibility criteria under the bill, you may enroll yourself and your dependents only in medical and dental coverage.

Note: You cannot enroll in dental only.

Can I enroll my dependents?

Yes. See Are my dependents eligible?

Can my dependents and I enroll in different plans?

Generally you and your dependents must enroll in the same medical plan. However there are exceptions when you have a dependent on your account who is not eligible for Medicare. These are listed in the table below.

If the person enrolled in Medicare enrolls in:	The non-Medicare members on your account:
Kaiser Permanente NW	Will be enrolled in Kaiser Permanente NW Classic
Kaiser Permanente WA Medicare Plan	Will choose to enroll in Kaiser Permanente WA Classic, SoundChoice, or Value
Premera Blue Cross Medicare Supplement Plan G UnitedHealthcare PEBB Balance UnitedHealthcare PEBB Complete	Will be enrolled in UMP Classic

If I am enrolled in SEBB coverage, can I also enroll in PEBB retiree coverage?

Yes. Dual enrollment between PEBB retiree coverage and SEBB coverage is allowed.

If you are enrolled in SEBB coverage and also enroll in PEBB retiree coverage, you will pay monthly premiums under both programs.

After I enroll in PEBB retiree coverage, may I defer later?

Yes. For more information, see How do I defer?

How much does PEBB retiree coverage cost?

See the Retiree Monthly Premiums.

How do I compare my plan options?

Compare PEBB Medicare plans with the Medicare Benefits Comparison or the online benefits comparison tool. Compare PEBB dental plans with the Dental Benefits Comparison.