Who to contact for help

There are some organizations you will work with to access benefits. Read below for an overview of the benefits each organization provides, and when you will interact with them.

PEBB Customer Service

PEBB customer service is your point of contact for eligibility and enrollment questions. Send a secure message and submit forms and documents through HCA Support or call 1-800-200-1004 (TRS: 711).

PEBB lobby services

Get in-person help with forms, enrollment, and other questions at the Health Care Authority’s lobby. Lobby hours are 8 a.m. to 4 p.m., Monday through Friday. The PEBB Program does not take appointments. Visitors are seen on a first-come, first-served basis.

Address
626 8th Ave
Olympia, WA 98501

Plans

Contact your plans for help with:

• ID cards
• Benefits
• Finding a provider
• Checking if your medications are covered
• Claims

SHIBA

Statewide Health Insurance Benefits Advisors (SHIBA) is a free, unbiased and confidential service of the Washington state Office of the Insurance Commissioner, SHIBA volunteers help people of all ages and backgrounds with their Medicare questions and options.

Department of Retirement Systems (DRS)

DRS manages and distributes your state and retirement pension. The pension amount depends on how long you work in public service, your salary, and in some cases, your investment plans.

Visit the DRS website or call 1-800-547-6657.

Social Security Administration (SSA)

Social Security provides you with a monthly check that replaces part of your income when you reduce your hours or stop working altogether.

Visit the Social Security Administration website or call your local office by using the Office Locator, or the national number at 1-800-772-1213.

Webinars

Join us for an overview of retiree health insurance available through the PEBB Program. Learn about eligibility criteria, medical, dental, and vision plans available, monthly premiums, and how to enroll. Register for an upcoming retirement webinar.

Plan comparison tools

Benefits comparisons, benefits booklets, and Summary of Benefits and Coverage documents help you compare costs and plan benefits.

Visit Medical benefits, Dental benefits, and Vision benefits.

Medicare and turning age 65

When you or your dependent turns age 65 you are required to enroll in Medicare. Learn about Medicare and what you have to do to keep your PEBB retiree health plan. Visit Medicare and turning age 65.

What Medicare covers

Medicare Part A covers inpatient hospital stays and Part B covers doctor services, some vaccines and equipment. You will sign up for Medicare Part A and Part B through SSA.

Eligible dependents

You may enroll the following dependents: 

• Your legal spouse
• Your state-registered domestic partner (SRDP)
  • This includes substantially equivalent legal unions from other jurisdictions.
  • Strict requirements apply to these partnerships, including that one partner is age 62 or older and you live in the same residence. 
• Children through the last day of the month in which they turn age 26, regardless of marital status, student status, or eligibility for coverage under another plan. This also includes children age 26 or older with a disability.

For legal definitions, refer to related laws and rules at the bottom of the page.

Definition of children

For our purposes, the definition of children includes:

• Children with whom you have a parent-child relationship, except when parental rights have been terminated.
• Children of your spouse or state-registered domestic partner with whom they have a parent-child relationship, except when parental rights have been terminated.
• Children you are legally required to support ahead of adoption.
• Children named in a court order or divorce decree for whom you are legally required to provide support or health care coverage.
• Children of any age with a developmental or physical disability who meet specific eligibility criteria described below.
• Extended dependents who meet specific eligibility criteria described below.

Extended dependents

Extended dependents may include a grandchild, niece, nephew, or other child for whom you, your spouse, or your state-registered domestic partner are legal custodians or legal guardians. The legal responsibility is demonstrated by a valid court order and the child’s official residence with the custodian or guardian.

Foster children are not extended dependents unless you, your spouse, or your SRDP are legally required to provide support ahead of adoption.

Children with disabilities

Eligible children include children of any age with a developmental or physical disability that leaves them incapable of self-sustaining employment and chiefly dependent upon the subscriber for support and ongoing care. Their condition must have occurred before they turned age 26.

When enrolling these dependents, you must provide proof of the disability, dependency, and proof the condition occurred before age 26. New subscribers must submit the PEBB Certification of a Child with a Disability within the 60-day enrollment period. 

If you have already enrolled a child with a disability and are changing to a medical plan administered by a different insurance carrier, you will need to submit a new PEBB Certification of a Child with a Disability, even if they were previously certified.

Surviving dependents eligibility

If you die, your dependents (a spouse, SRDP, or dependent child) may be eligible to enroll in or defer PEBB retiree insurance coverage as your survivor. Learn about their options.

Provide proof of dependent eligibility

Dependent verification is the process that requires you to submit documents proving their eligibility. This process ensures the PEBB Program only covers people who qualify. We will not enroll a dependent if we cannot verify their eligibility. We reserve the right to review eligibility at any time. 

There are two exceptions: 

• Extended dependent children are reviewed through a separate process. For details, download the PEBB Extended Dependent Certification.
• Dependents previously verified by the School Employees Benefits Board (SEBB) Program. This verification may be used when a subscriber and their dependent moves from SEBB Program coverage to PEBB Program coverage. 

When to provide dependent verification documents

You'll need to provide verification documents when enrolling a spouse, state-registered domestic partner, and children. 

Accepted documents

Birth certificates, adoption decrees, tax returns, and court ordered parenting plans are among the types of documents you can use to prove eligibility.

All documents must be submitted in English. Documents written in another language must include a translated copy prepared by a professional translator and certified with a notary public seal.

Upload your documents in Benefits 24/7 under the "Document upload" section, or submit your documents to the PEBB Program.

To enroll a spouse

Along with your enrollment forms, provide a copy of (choose one):

• The most recent year's federal tax return (black out financial information), either:
• A single return that lists your spouse if you filed jointly.
• Each return for you and your spouse if filed separately.
• A marriage certificate and proof that the marriage is still valid (you do not have to live together), such as a utility bill, life insurance beneficiary document, or bank statement, within the last six months showing both your and your spouse's name (black out any financial information). If within six months of marriage, only the certificate is required. Separate utility bills with the same address showing both your and your spouse's name on it may be provided for proof that the marriage is still valid.
• Petition for dissolution, petition for legal separation, or petition to invalidate (annul) marriage. Must be filed within the last six months.
• Defense Enrollment Eligibility Reporting System (DEERS) registration
• Valid J-1 or J-2 visa issued by the U.S. Government

To enroll a state-registered domestic partner or partner of a legal union

Along with your enrollment forms and the PEBB Declaration of Tax Status (to indicate whether they qualify as a dependent for tax purposes), provide a copy of (choose one):

• Certificate/card of a state-registered domestic partnership or a legal union and proof the partnership is still valid (you do not have to live together), such as a utility bill, life insurance beneficiary document, or bank statement dated within the last six months showing both your and your partner's name (black out any financial information). If within six months of state registration, only the card is required. Separate utility bills with the same address showing both your and your partner's name on it may be provided for proof that the partnership is still valid.
• Petition to invalidate (annul) (recently filed, within the last six months) a state-registered domestic partnership.

If you are enrolling a partner of a legal union also provide:

• Proof of Washington State residency for both you and your partner.

Additional dependent verification documents will be required within one year of the partner's enrollment for them to remain enrolled. More information can be found in PEBB Program Administrative Policy 33-1.

To enroll children

Along with your enrollment forms, provide a copy of a (choose one):

• The most recent year's federal tax return that includes the child as a dependent (black out financial information)
  You can submit one copy of your tax return if it includes all family members that require verification.
• Birth certificate (or hospital certificate with the child's footprints on it) showing the name of the parent who is the subscriber, the subscriber's spouse, or the subscriber's state-registered domestic partner.
  If the dependent is the subscriber's stepchild, the subscriber must also verify the spouse or state-registered domestic partner in order to enroll the child, even if not enrolling the spouse or state-registered domestic partner in PEBB insurance coverage.
• Certificate or decree of adoption showing the name of the parent who is the subscriber, the subscriber's spouse, or the subscriber's state-registered domestic partner
• Court-ordered parenting plan
• National Medical Support Notice
• Defense Enrollment Eligibility Reporting System (DEERS) registration
• Valid J-2 visa issued by the U.S. Government

Related laws and rules

Revised Code of Washington (RCW) and Washington Administrative Code (WAC) are the official rules used for PEBB Program eligibility.

• RCW 26.26A.100: Establishment of parent-child relationship.
• RCW 26.60.020(1): Definition of state registered domestic partner.
• RCW 26.60.090: Legal union reciprocity with other jurisdictions.
• WAC 182-12-109: Definitions of terms used by the Public Employees Benefits Board (PEBB).
• WAC 182-12-260: Who are eligible dependents?

PEBB plans that include Part D

• Kaiser Permanente NW Senior Advantage with Part D
• Kaiser Permanente WA Medicare Advantage with Part D
• Uniform Medical Plan (UMP) Classic Medicare with Part D (PDP)
• UnitedHealthcare PEBB Balance
• UnitedHealthcare PEBB Complete

Advantages to Medicare Part D plans

Medicare Part D plans are subject to the Inflation Reduction Act (IRA) of 2022, which introduced several changes to Part D intended to lower costs, including:

• A yearly out-of-pocket maximum
• Eliminating the “donut hole” gap in coverage.
• A six percent limit on yearly base premium increases.
• Medicare’s ability to negotiate with drug manufacturers for some costly brand-name drugs.

Member benefits include:

• Prior authorization and step therapy requirements are generally less restrictive.
• By Law, Part D appeals must be resolved in 72 hours (24 hours for urgent appeals).

Covered drugs

Each Part D plan negotiates its own list of covered drugs (formulary). These drugs are grouped into price tiers that usually include preferred and nonpreferred generic drugs and brand name drugs.

All Medicare drug plans generally must cover at least two drugs per drug category but plans can choose drugs they will cover. Medicare also has six protected classes of drugs, for which all or nearly all drugs are covered by Part D. They are antidepressants, antipsychotics, anticonvulsants, immunosuppressants, antiretrovirals, and antineoplastics.

See the plans’ formularies

• Kaiser Permanente NW Senior Advantage with Part D
• Kaiser Permanente WA Medicare Advantage with Part D
• UMP Classic Medicare with Part D
• UnitedHealthcare PEBB Balance and PEBB Complete

Cost of prescriptions

Contact your planto learn about formularies and out-of-pocket costs.

Restrictions

Enrollment

To be enrolled in a Medicare Part D plan, you must permanently live in the United States. Medicare Part D does not cover drugs purchased outside the U.S. and will not reimburse you for any drugs purchased in other countries.

Using manufacturer coupons

You cannot use manufacturer coupons for your prescriptions. A federal law called the Anti-Kickback Statue (AKS) makes it illegal for drug companies to give money or other incentives to Medicare patients to purchase drugs. This is why you cannot use manufacturer coupons with a Part D plan. Federal subsidies and manufacturer discounts already cover a significant portion of drug costs for Part D plans, which results in lower premiums.

Savings with Medicare Part D coverage

Consider these strategies to help save on prescription costs:

• Medicare Part D Extra Help program. Based on your income and other factors, you may qualify for help with paying your monthly premium, yearly deductible, and prescription copayments. Extra Help can also count toward your out-of-pocket costs.
• Medicare Prescription Payment Plan. If you think you will reach the $2,000 out-of-pocket maximum, you may be interested in the Medicare Prescription Payment Plan. This option can help you manage your out-of-pocket costs for covered drugs by spreading them across the calendar year.
• Ordering a 90-day supply of your prescriptions through your plan’s mail order pharmacy. For many plans, a 90-day supply of covered drugs costs only twice as much as a 30-day supply. Note: Most plans limit specialty drugs to a 30-day supply. Contact your plan for details.

IRMAA

If your income is above a certain level, the Social Security Administration (SSA) determines the Income Related Monthly Adjustment Amount (IRMAA) you may pay in addition to your Medicare Part B and Part D premiums. Contact the SSA for specific information on your IRMAA. Learn more at Medicare Interactive: Part D costs for those with higher incomes.

What is the PEBB Program?

The PEBB Program negotiates health care, which includes medical, dental, vision, life insurance and other benefits for public employees in Washington State, acting as a bridge between insurance plan providers and retirees. We advocate on behalf of our members to ensure our retirement plan benefits outpace those on the open market. We provide tools and educational resources to our members to help them choose plans that work best for their lifestyles and needs.

What coverage does the PEBB Program offer?

PEBB retiree insurance coverage benefits includes:

Medical coverage

All plans (except Medicare Supplement Plans) cover the same basic benefits and provide prescription drug coverage that is Medicare Part D or comparable to Medicare Part D coverage. Learn about medical plan options.

Medicare members

PEBB offers the following Medicare plan options. These are available if you or a dependent are enrolled in Medicare Part A and Part B.

• 1 Original Medicare plan - UMP Classic Medicare with Part D (PDP)
• 4 Medicare Advantage Prescription Drug (MAPD) plans - offered by Kaiser Permanente or UnitedHealthcare
• 1 Medicare Supplement Plan - offered by Premera Blue Cross

Members not enrolled in Medicare

• 2 preferred provider plans
• 3 consumer directed health plans
• 4 managed-care (limited network) plans

Dental coverage

PEBB offers the following dental plan options:

• 1 preferred provider plan
• 2 managed-care plans

Learn about dental coverage.

Vision coverage (for members not enrolled in Medicare)

PEBB offers three vision plans available to members not enrolled in Medicare. (Medicare plans except for Medicare Supplement Plans include vision coverage.)

Learn about vision coverage.

Retiree term life insurance

You may be eligible to purchase retiree term life insurance through MetLife on a self-pay basis. Retiree term life insurance is available to subscribers who meet the PEBB Program's retiree eligibility requirements, had life insurance through PEBB or SEBB Program as an employee and are not on a waiver of premium due to disability.

Learn about retiree term life insurance.

FAQs

How much does it cost?

View Retiree Monthly Premiums.

How do I pay?

You have three options for paying for PEBB retiree insurance coverage:

• Pension deduction
• Automatic bank account withdrawals (electronic debit service)
• Monthly invoice

Learn about paying for coverage.

How do I enroll?

The easiest way to enroll is with the online enrollment system, Benefits 24/7. View New retiree enrollment to learn how to enroll.