The PEBB Program’s annual open enrollment is November 1 through 30. Learn more.

How to determine eligibility

Find out if you are eligible for PEBB retiree benefits.

Who is eligible for PEBB retiree insurance coverage?

You may be eligible to enroll in PEBB retiree insurance coverage if:

You are a retiring employee of a:

  • PEBB-participating employer group.
  • State agency.
  • State higher-education institution.

You are a retiring school employee of a:

  • Washington State school district, educational service district, or charter school that participates in the School Employees Benefits Board (SEBB) Program.
  • A non-represented employee of an educational service district.

You may also be eligible to enroll in PEBB retiree insurance coverage if you are:

  • A surviving dependent eligible to continue enrollment in PEBB retiree insurance coverage.
  • An elected or full-time appointed official of the legislative or executive branch of state government who voluntarily or involuntarily leaves public office.

To be eligible to enroll in PEBB retiree insurance coverage, you must meet both the procedural requirements and all eligibility requirements of WAC 182-12-171, 182-12-180, 182-12-211, 182-12-250, or 182-12-265.

Eligibility requirements

Certain eligibility and procedural requirements must be met to receive PEBB retiree insurance coverage.

Procedural requirements

  1. If you are a retiring employee or retiring school employee, you must submit the required forms to enroll  or defer enrollment in PEBB retiree insurance coverage.  The PEBB Program must receive your forms no later than 60 days after your employer-paid, COBRA, or continuation coverage ends. If you are an elected or full-time appointed officials described in WAC 182-12-180(1), the PEBB Program must receive your forms no later than 60 days after you leave public office.  If you are a dependent becoming eligible as a survivor, see If I die, are my dependents eligible or Eligibility for survivors of emergency service employees. If you do not submit an application to enroll or defer enrollment within the required timeline, you lose all rights to enroll in PEBB retiree insurance coverage in the future.
  2. If you or a dependent is entitled to Medicare and your retirement date is after July 1, 1991, you must enroll (and stay enrolled) in Medicare Part A and Part B to be eligible and remain eligible for a PEBB retiree health plan.
  3. If you do not enroll in PEBB retiree insurance coverage at retirement, when eligible and separating from service, or when leaving public office as an eligible official, you are only eligible to enroll at a later date if you defer (postpone) enrollment and maintain continuous enrollment in other qualifying medical coverage as described in WAC 182-12-200 and 182-12-205.  See deferring coverage.If you are a retiring employee or retiring school employee, you must submit the required forms to enroll  or defer enrollment in PEBB retiree insurance coverage.  The PEBB Program must receive your forms no later than 60 days after your employer-paid, COBRA, or continuation coverage ends. If you are an elected or full-time appointed officials described in WAC 182-12-180(1), the PEBB Program must receive your forms no later than 60 days after you leave public office.  If you are a dependent becoming eligible as a survivor, see surviving dependents or survivors of emergency service employees. If you do not submit an application to enroll or defer enrollment within the required timeline, you lose all rights to enroll in PEBB retiree insurance coverage in the future.

In general, the eligibility requirements state 

  1. You must be a vested member and meet the eligibility criteria to retire from a Washington State-sponsored retirement plan when your employer coverage, COBRA coverage, or continuation coverage ends, unless you are an elected full-time appointed official as described in WAC 182-12-180. 
  2. Washington State-sponsored retirement plans include:
    1. Public Employees’ Retirement System (PERS) 1, 2, or 3
    2. Public Safety Employees’ Retirement System (PSERS) 2
    3. Teachers Retirement System (TRS) 1, 2, or 3
    4. Washington Higher Education Retirement Plan (HERP) (for example, TIAA-CREF)
    5. School Employees’ Retirement System (SERS) 2 and 3
    6. Law Enforcement Officers’ and Fire Fighters’ Retirement System (LEOFF) 1 or 2
    7. Washington State Patrol Retirement System (WSPRS) 1 or 2
    8. State Judges/Judicial Retirement System
    9. Civil Service Retirement System and Federal Employees’ Retirement System are considered a Washington State-sponsored retirement system for Washington State University Extension for an employee covered under PEBB insurance coverage at the time of retirement.
  3. Plan 1 and 2 members under a Washington state-sponsored retirement plan with the Department of Retirement Systems (DRS) must immediately receive a monthly retirement plan payment or lump sum payment as allowed by the plan.

    Plan 3 members under a Washington state-sponsored retirement plan with DRS are not required to receive a retirement plan payment or lump sum payment, but must meet the retirement plan’s eligibility criteria.

    Washington State higher-education retirement plan members, must meet their plan’s retirement eligibility criteria, or be a least age 55 with 10 year of state service.  They do not have to receive a monthly retirement plan payment.

    Employees retiring from a PEBB participating employer group that does not participate in a Washington State-sponsored retirement plan, do not have to receive a monthly retirement plan payment.  However, must meet the same age and years of service requirements as if they had been employed as a member of PERS Plan 1 or Plan 2.

    If you are an elected or a full-time appointed official of the legislative or executive branches of state government, you do not have to meet the age and years of service requirement or receive a monthly retirement plan payment from a state-sponsored retirement system.

Are my dependents eligible?

You may enroll the following dependents as described in WAC 182-12 260:

  • Your legal spouse
  • Your state-registered domestic partner, as defined in WAC 182-12-109 and RCW 26.60.020(1) and substantially equivalent legal unions from other jurisdictions as defined in RCW 26.60.090 Strict requirements apply to these partnerships including that one partner is age 62 or older and you live in the same residence..
  • Your children through the last day of the month in which they become age 26, except for children with a disability (who may be covered past the age of 26 if they qualify).

The PEBB Program verifies the eligibility of all dependents and will request proof of a dependent’s eligibility. We will not enroll a dependent if we cannot verify the dependent’s eligibility. See Dependent verification.

If I die, are my surviving dependents eligible?

As an eligible employee, school employee, or retiree, your surviving dependent(s) may be eligible to enroll or defer enrollment in PEBB retiree insurance coverage as a survivor if they meet both the procedural and eligibility requirements outlined in WAC 182-12-180 or 182-12-265. The PEBB Program must receive all required forms to enroll or defer enrollment in PEBB retiree insurance coverage within the following timelines:

  • For an eligible survivor of an employee, (including elected or full-time appointed officials) or a school employee, no later than 60 days after the date of the employee’s or the school employee’s death, or the date the survivor’s PEBB,  educational service district, or SEBB insurance coverage ends, whichever is later.
  • For an eligible survivor of a retiree, no later than 60 days after the retiree’s death.

Eligibility for survivors of emergency service employees

If you are a surviving spouse, state-registered domestic partner, or dependent child of an emergency service employee who was killed in the line of duty, you may be eligible to enroll or defer enrollment in PEBB retiree insurance coverage if you meet both the procedural and eligibility requirements outlined in WAC 182-12-250. The required forms to enroll or defer enrollment in PEBB retiree insurance coverage must be received by the PEBB Program no later than 180 days after the later of:

  • The death of the emergency service worker.
  • The date on the letter from the Department of Retirement Systems or the board for volunteer firefighters and reserve officers that informs the survivor that they are determined to be an eligible survivor.
  • The last day the surviving spouse, state-registered domestic partner, or child was covered under any health plan through the emergency service worker’s employer.
  • The last day the surviving spouse, state-registered domestic partner, or child was covered under the Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage from the emergency service worker’s employer.

What happens when a dependent loses eligibility?

You must notify the PEBB Program in writing when your dependent  no longer meets the eligibility criteria described in WAC 182-12-260 due to divorce, annulment, dissolution, or a qualifying event of a dependent ceasing to be eligible as a dependent child. We must receive notice within 60 days of the last day of the month your dependent loses eligibility for health plan coverage.

How are children defined?

Children are defined based on the establishment of a parent-child relationship as described in RCW 26.26A.100, except when parental rights have been terminated. This definition includes:

  • Your children.
  • Children of your spouse.
  • Children whose support is your legal obligation in anticipation of adoption.
  • Children of your state-registered domestic partner.
  • Children specified in a court order or divorce decree for whom you have a legal obligation to provide support or health care coverage.

Eligible extended dependents

Children may also include extended dependents in your, your spouse’s, or your state-registered domestic partner’s, legal custody or legal guardianship. An extended dependent may be your grandchild, niece, nephew, or other child for whom you, your spouse, or state-registered domestic partner have legal responsibility as shown by a valid court order and the child’s official residence with the custodian or guardian. This does not include foster children unless you, your spouse, or your state-registered domestic partner has assumed a legal obligation for their support in anticipation of adoption.

Eligible children with a disability

Eligible children also include children of any age with a developmental or physical disability that renders the child incapable of self-sustaining employment and chiefly dependent upon the subscriber for support and ongoing care, provided the condition occurred before the age of 26. You must provide proof of the disability and dependency within 60 days of the child’s attainment  of age 26.

The PEBB Program with input from your medical plan will verify the disability and dependency of a child with a disability periodically beginning at age 26, but no more frequently than annually after the two-year period after the child turns age 26.  These verifications may require renewed proof from you.

A child with a developmental or physical disability who becomes self-supporting is no longer eligible as a dependent child as of the last day of the month they become capable of self-support. If the child becomes capable of self-support and later becomes incapable of self-support, the child does not regain eligibility as a child with a disability.