Paying for benefits
Learn about payment options for your PEBB retiree benefits.
Important! Premiums and applicable premium surcharges are collected for the full month and will not be prorated for any reason, including when a member dies or requests to cancel coverage during a month.
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What do I pay?
There are several costs that may apply, depending on your situation.
Note that when you enroll, you must pay premiums and applicable premium surcharges back to the date your other coverage ended. You cannot have a gap in coverage. For example, 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 PEBB retiree insurance coverage.
- Monthly premiums (required)
You pay monthly premiums for:
- Medical benefits for yourself and any enrolled dependents on your account.
- Dental benefits, if you choose to enroll.
- Retiree term life insurance, if you are eligible and choose to enroll.
- Premium surcharges (based on your situation)
In addition to your monthly medical premium, non-Medicare subscribers may be charged a $25 tobacco use premium surcharge for using tobacco products. You may also be charged a monthly $50 spouse or state-registered domestic partner coverage premium surcharge to enroll your spouse if they have other coverage available.
- Out-of-pocket costs (required)
You are responsible for paying any out-of-pocket costs for deductibles, coinsurance, or copayments for services under the medical and dental plans you choose.
How do I pay?
You have three options to pay for PEBB retiree insurance coverage. In most cases, you must make your first payment by check before we can enroll you.
Making your first payment
Send your first payment to HCA no later than 45 days after your 60-day election period ends. If we do not receive your first payment by the deadline, you will not be enrolled and you may lose your right to enroll in PEBB retiree insurance coverage. In most instances, you will not be enrolled in coverage until payment is received.
Make checks payable to Health Care Authority and send to:
- Health Care Authority
PO Box 42691
Olympia, WA 98504-2691
- Pension deduction
Your payments are taken from your end-of-the month pension through the Department of Retirement Systems (DRS). For example, if your coverage takes effect January 1, your January 31 pension will show your deductions for January.
Important! Due to timing issues with DRS, you may receive an invoice for any premiums and applicable premium surcharges not deducted from your pension when you first enrolled. We will send you an invoice if a first payment is needed. If you receive an invoice, your payment is due by the deadline listed on it.
- Electronic debit service (EDS)
You can pay through automatic bank withdrawals. To choose this option, submit the PEBB Electronic Debit Service Agreement. You cannot make your first payment through EDS because approval takes six to eight weeks. In the meantime, please make payments as invoiced until you receive a letter from us with your EDS start date.
- Monthly invoice
We will send you a monthly invoice after your first premium payment is made. Payments are due on the 15th of each month for that month of coverage. Send your payment to the address listed on the invoice.
Can I use a VEBA account to pay my premiums?
Yes. If you have a Voluntary Employees' Beneficiary Association Medical Expense Plan (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.
Qualified insurance premiums include:
- Medicare Supplement
- Medicare Part B
- Medicare Part D
- 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.
Are there limits with my VEBA MEP?
Yes. Your VEBA MEP account is a health reimbursement arrangement (HRA) and certain limits apply:
- Retiree rehire limitation: You must notify the VEBA MEP if your employer that set up your account rehires you. Only certain limited or "excepted" qualified medical care expenses and premiums (for example: out-of-pocket expenses for dental, vision, and qualified long-term care) you incur while you are reemployed are eligible for reimbursement.
- 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 want to become eligible for health savings account (HSA) contributions, you must limit your VEBA MEP HRA coverage by submitting a Limited HRA Coverage Election form to VEBA.
More information and forms, including the Automatic Premium Reimbursement form and Limited HRA Coverage Election form, are available after logging into the VEBA website or by calling the VEBA MEP customer care center at 1-888-828-4953.
What happens if I miss a payment?
You must pay the monthly premium and applicable premium surcharges for your PEBB retiree health plan coverage when due. They will be considered unpaid if one of the following occurs:
- You make no payment for 30 days past the due date.
- You make a payment, but it is less than the total due by an amount greater than an insignificant shortfall (for a definition, see related laws and rules). The remaining balance stays underpaid for 30 days past the due date.
If either of these events occur and the payment remains unpaid for 60 days from the original due date, the PEBB Program will terminate your coverage back to the last day of the month for which the monthly premium and applicable premium surcharges were paid. If you were enrolled in a Medicare Advantage plan, it will terminate at the end of the month after the month your termination notice was sent. We will also terminate coverage for any enrolled dependents.
Can I reenroll?
You cannot enroll again unless you regain eligibility. You can do so, for example, by returning to work with a PEBB employing agency or School Employees Benefits Board (SEBB) organization in which you are eligible for PEBB or SEBB benefits.
Related laws and rules
- WAC 182-08-015: Definitions.
The PEBB Program
Hours: 8 a.m. to 4:30 p.m., Monday through Friday