If you are displaced or affected by wildfire, all Washington Apple Health and PEBB/SEBB medical plans are allowing prescription refills before the refill date.
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Paying for benefits
Find out how to pay for your PEBB retiree benefits.
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You must send your first premium payment and applicable premium surcharges to the Health Care Authority (HCA) no later than 45 days after your 60-day election period ends (unless you elect to pay by pension deduction through the Department of Retirement Systems). If we do not receive your first premium payment including applicable premium surcharges within the deadline, you will not be enrolled, and you may lose your right to enroll in PEBB retiree insurance coverage.
Please make checks payable to Health Care Authority and send to:
Health Care Authority
PO Box 42691
Olympia, WA 98504-2691
You can help ensure that future payments are made on time and avoid disruptions in your coverage by using pension deduction through the Department of Retirement Systems (DRS) or electronic debit service (EDS) automatic bank account withdrawals. Here are your payment options:
Your premium and applicable premium surcharges are taken from your end-of-the-month pension check. For example, if your coverage takes effect January 1, your January 31 pension will show your deductions for January. Due to timing issues with DRS, you may receive an invoice for premiums and applicable premium surcharges not deducted from your pension when you first enrolled. The PEBB Program will send you an invoice if a first payment is needed.
Electronic Debit Service (EDS)
You must submit a PEBB Electronic Debit Service Agreement to the HCA. You cannot make your first premium payment through EDS. Approval takes six to eight weeks; you must continue to pay your monthly premiums and applicable premium surcharges as invoiced until you receive a letter from the HCA with your EDS start date.
A personal check or money order
You will receive a monthly invoice from the HCA for your monthly premiums and applicable premium surcharges. Payments are due on the 15th of each month for that month of coverage. Send payment to the address listed on the invoice.
Note: HCA collects premiums for the full month, and will not prorate them for any reason, including when a member passes away or cancels (terminates) coverage before the end of the month.
When you enroll, you must pay premiums and applicable premium surcharges back to the date when your other coverage ended. You cannot have a gap in coverage. For example, if your other coverage ends in December, but you don’t submit your enrollment form until February, you must pay premiums and applicable premium surcharges for January and February to enroll in coverage.
HCA collects premiums and applicable premium surcharges for the full month and does not prorate them for any reason, including when a member passes away before the end of the month. When you become eligible as a surviving dependent, you will move from being a dependent to having your own subscriber account. You cannot have a gap in coverage between these accounts. As a result, you must pay the premiums and applicable premium surcharges for the month the subscriber passed away, in addition to the premiums and applicable premium surcharges for your first month under your own PEBB account.
If your monthly premiums and applicable premium surcharges were deducted from your deceased spouse or state-registered domestic partner’s pension through the Department of Retirement Systems (DRS), this will stop. You may be eligible for a survivor’s pension from DRS. To find out, call DRS at 1-800-547-6657.
You will receive two separate invoices from the HCA—one for the month the subscriber passed away, and one for your first month under your own PEBB account.
If premiums and applicable premium surcharges remain unpaid for the month in which your spouse or state-registered domestic partner passed away, your PEBB retiree health plan coverage will be terminated back to the last day of the month in which the premium and applicable surcharge were paid. This may cause a gap in coverage, which means that any claims paid from the month the subscriber passed to the current month would be your financial responsibility. If you are terminated, you may not be able to enroll again unless you regain eligibility in the future.
The Voluntary Employees’ Beneficiary Association Medical Expense Plan (VEBA MEP) does not pay your monthly premiums directly to the PEBB Program. If you have a (VEBA MEP) account, you can set up automatic reimbursement of your qualified insurance premiums. It is important that you notify the VEBA MEP when your premium changes.
Your VEBA MEP account is a health reimbursement arrangement (HRA). Qualified insurance premiums include medical, dental, vision, Medicare supplement, Medicare Part B, Medicare Part D, and tax-qualified long-term care insurance (subject to annual IRS limits). Retiree term life insurance premiums are not eligible for reimbursement from your VEBA MEP account.
- Retiree Rehire Limitation: You must notify the VEBA MEP if you become rehired by the employer that contributed to your account. Only certain limited or “accepted” qualified medical care expenses and premiums you incur while you are reemployed are eligible for reimbursement. Accepted benefits include expenses and premiums for dental, vision, and tax-qualified long-term care insurance (subject to annual IRS limits). You can still be reimbursed for all types of qualified medical care expenses incurred prior to and after reemployment.
- HSA Contribution Eligibility Limitation: If you want to enroll in a consumer-directed health plan (CDHP) or other qualified high-deductible health plan (HDHP) and become eligible to make or receive contributions to a health savings account (HSA), you must limit your VEBA MEP (HRA) coverage by submitting a Limited HRA Coverage Election form to VEBA. Only the following types of expenses and premiums can be reimbursed from your VEBA MEP account while coverage is limited: CDHP/HDHP premiums; dental expenses and premiums; vision expenses and premiums; orthodontia expenses; and transportation expenses (if related to a permitted expense). Keep in mind that limiting your VEBA MEP coverage is not the only HSA contribution eligibility requirement.
More information and forms, including the Automatic Premium Reimbursement form and Limited HRA Coverage Election form, are available at www.veba.org (after logging in to your account) or by calling the VEBA MEP customer care center at 1-888-828-4953.
You must pay the monthly premium and applicable premium surcharges for your PEBB retiree health plan coverage when due. The monthly premium will be considered unpaid if one of the following occurs:
- No premium or applicable premium surcharges are paid and remain unpaid for 30 days; or
- A premium payment or applicable premium surcharges are underpaid by an amount greater than an insignificant shortfall (described in WAC 182-08-015) and remains underpaid for 30 days past the due date.
If either of the events listed above occur and the payment remains unpaid for 60 days from the original due date, the PEBB Program will terminate your PEBB retiree health plan coverage back to the last day of the month for which the monthly premium and applicable premium surcharges were paid. If your PEBB retiree health plan coverage is terminated, coverage for your dependents is also terminated. You cannot enroll again unless you regain eligibility, for example, by returning to employment in a PEBB or School Employees Benefits Board (SEBB) benefits-eligible position.