Going on or returning from leave

Providing required notice

Written notice must be provided to employees once they are identified as:

• Leaving work to go on approved leave or appealing a dismissal, and
• Returning to work following a period of leave during which they were not eligible for the employer contribution toward PEBB benefits.

Provide required notice by completing the eligibility worksheet that best fits the employee's scenario. The worksheets are located on the Eligibility worksheets page for state agencies and higher ed or the Notification requirements page for employer groups.

Maintaining eligibility while on approved leave

Employees leaving work under the following circumstances continue to receive the employer contribution toward PEBB benefits only for the months they are in pay status of 8 hours or more (or 5% of full-time for faculty):

• Authorized leave without pay (LWOP)
• Called to active military duty in the uniformed services as defined under the Uniformed Services Employment and Reemployment Rights Act (USERRA) for more than 31 days
• Approved educational leave
• Appealing a dismissal
• Receiving time-loss benefits under workers' compensation
• Applying for disability retirement

When eligibility is maintained while on approved leave:

• Leave the employee enrolled in benefits in Benefits 24/7 each month in which they are in pay status of 8 or more hours per month (or 5% of full-time for faculty).
  • During the first 90 days of an approved leave of absence, employee-paid long-term disability (LTD) insurance is continued, but LTD premium payments are waived. Leave the employee enrolled in employee-paid LTD but waive the premiums in Benefits 24/7. After 90 days, remove the waiver and start collecting the employee-paid LTD premium.
    • See the chapter 3 of the Benefits 24/7 manual for instructions on how to enter the premium waiver. If Outreach & Training keys for you, send a message through HCA Support to request that the employee's LTD premium be waived.

  • Employees approved for federal FMLA or who are called to active military duty may choose to cease all or part of their flexible spending arrangement contributions, consistent with the requirements of FMLA or the Uniformed Services Employment and Reemployment Rights Act (USERRA). Contact Navia for more information.

• Make arrangements with employees to collect premiums. Employees may pay their premiums through payroll deduction, by prepaying, or paying-per-month.

FMLA, PFML that is concurrent with FMLA, and active military duty for less than 31 days

The sections below provide information about maintaining eligibility for the employer contribution toward PEBB benefits for employees going on approved FMLA or PFML that is concurrent with FMLA, and those who are called to active military duty for less than 31 days.

Family and Medical Leave Act (FMLA)

Maintaining eligibility for PEBB benefits while on approved FMLA

Typically, eligibility is maintained when the employee is in pay status of 8 or more hours per month (WAC 182-12-131). However, if the criteria in WAC 182-12-131 is not met, eligibility is continued if the employee is approved under FMLA, the federal Family and Medical Leave Act (WAC 182-12-138).

Who determines an employee's eligibility for FMLA?

Eligibility for FMLA and the duration of such leave is determined by the employer (WAC 182-12-138).

Coverage options and premium payments

Employees have several options for continuing PEBB benefits and paying premiums while on approved FMLA.

• Medical coverage
  If enrolled in PEBB medical coverage (not previously waived), employees and their dependents remain enrolled unless medical coverage is waived due to a qualifying special open enrollment event.
  • Option 1: Continue enrollment in medical coverage
    • If continuing enrollment in medical, employees and their dependents remain enrolled in Benefits 24/7.
    • Payroll deduction: If using accrued leave, continue to deduct employee premiums. If accrued leave is not used, make arrangements with employees to prepay or pay-per-month for their premiums.
  • Option 2: Waive medical coverage due to a qualifying special open enrollment (SOE) event
    • If a qualifying SOE event occurs (e.g., birth or adoption), employees may choose to waive medical coverage (WAC 182-12-128). To waive medical coverage, employees must complete and submit the appropriate PEBB Employee Enrollment/Change form to their benefits administrator no later than 60 days after the event.
    • Proof of the event is required to waive medical coverage. Refer to the SOE matrix: Addendum 45-2A for details.

Visit the forms and publications webpage for manuals to find instructions on how to process changes Benefits 24/7.

• Dental, vision, basic life and AD&D insurance and employer-paid LTD insurance
  Employees remain enrolled in dental, vision, basic life, basic AD&D, and employer-paid long-term disability (LTD) during approved FMLA.
• Supplemental Life and AD&D insurance
  Employees may choose to either continue or defer (pause) enrollment in supplemental life and AD&D for themselves and their dependents.
  • Option 1: Continue supplemental life and AD&D
    • Payroll deduction: If using accrued leave, continue to deduct employee premiums. If they do not use accrued leave, make arrangements with employees to prepay or pay-per-month for their premiums.
    • Direct billing: If employees receive direct billing from MetLife, they continue to submit premium payments directly to MetLife.
  • Option 2: Defer enrollment in supplemental life and AD&D
    • To defer enrollment, employees must complete and submit the MetLife Cancellation of Supplemental Life Insurance form to MetLife.
    • When returning to work:
      • Employees must complete and submit the MetLife Enrollment/Change form to their benefits administrator.
      • The employer must submit the MetLife Notification of Enrollment Extension form and the employee's enrollment/change form to MetLife to reinstate the amount of supplemental life and AD&D insurance they had prior to going on leave, without requiring evidence of insurability (EOI).

Life and AD&D insurance premium waiver and accelerated life benefit

Employees may be eligible for a waiver of their life and AD&D insurance premiums, or the accelerated life benefit. Advise employees or their representatives to contact MetLife customer service for more information: 1-866-548-7139. Learn more about life and AD&D insurance.

• Employee-paid LTD insurance
  During the first 90 days of an approved leave of absence, employee-paid long-term disability (LTD) insurance is continued, but LTD premium payments are waived. Leave the employee enrolled in employee-paid LTD but waive the premiums in Benefits 24/7.
• Employees have two options following the 90-day premium waiver:
  • Option 1: Continue employee-paid LTD
    • Beginning on day 91, employee-paid LTD premiums must be reinstated.
    • Payroll deduction: If using accrued leave, deduct employee premiums. If accrued leave is not used, make arrangements with employees to prepay or pay-per-month for their premiums.
  • Option 2: Discontinue employee-paid LTD
    • To discontinue employee-paid LTD, employees must complete and submit the LTD Enrollment/Change form to their benefits administrator.
    • When returning to work:
      • Employees will be eligible to reinstate the same employee-paid coverage level (50% or 60%) that was in effect prior to leave, without providing EOI.
      • To reinstate coverage, employees must complete and submit the LTD Enrollment/Change form to their benefits administrator.

Visit the forms and publications webpage for manuals to find instructions on how to process changes Benefits 24/7 and see the LTD Administration manual to learn more.

Pro tip!

LTD claims should be filed as soon as the employee's last day (physically) on the job is known, if applicable. Do not wait for the 90-day waiting period or leave to be exhausted to file the claim. Learn how to file an LTD claim.

• Flexible Spending Arrangement (FSA) or Limited Purpose FSA
  Employees of state agencies and higher ed have the option to continue or discontinue participation in a PEBB FSA or Limited Purpose FSA.
  • Option 1: Continue participating in an FSA
    • Payroll deduction: If using accrued leave, continue to deduct employee contributions. If accrued leave is not used, make arrangements with employees to prepay their contributions.
      • To prepay the contribution, employees must complete and submit Navia's Change in Status form to their benefits administrator before going on approved leave.
  • Option 2: Discontinue participating
    • Employees must complete and submit Navia's Change in Status form to their benefits administrator.

When returning to work, employees must complete and submit Navia's Change in Status form to their benefits administrator no later than 60 days after the date they returned to work.

Employees have two options when resuming participation in an FSA:

• Option 1: Resume participation at the same coverage level by increasing the per-pay-period contribution for the balance of the plan year.
• Option 2: Resume participation at a reduced coverage level by continuing the same per-pay-period contribution for the balance of the plan year.

When approved FMLA ends

Employees who exhaust the period of leave approved under FMLA (or PFML that is concurrent with FMLA) will lose eligibility for the employer contribution, unless they meet the criteria to maintain eligibility, or they return to work.

PFML that is concurrent with FMLA

Maintaining eligibility for PEBB benefits while on approved PFML that is concurrent with FMLA

Typically, eligibility is maintained when the employee is in pay status of 8 or more hours per month (WAC 182-12-131). However, if the criteria in WAC 182-12-131 is not met, eligibility is continued if the employee is approved under PFML (Paid Family Medical Leave) when there is at least one day of concurrent use with leave taken under federal FMLA (WAC 192-700-020).

Concurrent use means that leave taken under approved PFML must follow and overlap with leave taken under approved FMLA.

Who determines an employee's eligibility for FMLA and PFML?

• Eligibility for FMLA and the duration of such leave is determined by the employer (WAC 182-12-138).
• Eligibility for PFML is determined by the Employment Security Department.

Scenario: Approved FMLA leave is taken starting November 1st and ends December 15^th. Eligibility will continue for the months of November and December. In order for PFML to continue eligibility beyond December, approved PFML must begin no later than December 15^th and extend at least into January.

• Following are two examples of how PFML would continue eligibility for the employer contribution:
  • Leave under PFML begins December 13^th and extends at least into January (PFML begins before FMLA ends)
  • Leave under PFML begins on December 15^th and extends at least into January (PFML begins on the same day FMLA ends)

In the examples above, PFML would continue eligibility until the duration of leave taken under PFML (which overlaps with at least one day of leave taken under FMLA) ends.

• Following are two examples of how PFML would not continue eligibility for the employer contribution:
  • Leave under PFML begins December 16th (PMFL begins after the FMLA ends)
  • Leave under PFML ends October 28th (PFML ends before FMLA starts)

PFML by itself, does not allow for employees to maintain/continue eligibility

Employees approved for PFML, that is not concurrent with FMLA, must meet the requirements described in the Maintaining eligibility while on approved leave section of this page.

Coverage options and premium payments

Employees have several options for continuing PEBB benefits and paying premiums while on approved PFML that is concurrent with FMLA.

• Medical coverage
  If enrolled in PEBB medical coverage (not previously waived), employees and their dependents remain enrolled unless medical coverage is waived due to a qualifying special open enrollment event.
  • Option 1: Continue enrollment in medical coverage
    • If continuing enrollment in medical, employees and their dependents remain enrolled in Benefits 24/7.
    • Payroll deduction: If using accrued leave, continue to deduct employee premiums. If accrued leave is not used, make arrangements with employees to prepay or pay-per-month for their premiums.
  • Option 2: Waive medical coverage due to a qualifying special open enrollment (SOE) event
    • If a qualifying SOE event occurs (e.g., birth or adoption), employees may choose to waive medical coverage (WAC 182-12-128). To waive medical coverage, employees must complete and submit the appropriate PEBB Employee Enrollment/Change form to their benefits administrator no later than 60 days after the event.
    • Proof of the event is required to waive medical coverage. Refer to the SOE matrix: Addendum 45-2A for details.

Visit the forms and publications webpage for manuals to find instructions on how to process changes in Benefits 24/7.

• Dental, vision, basic life and AD&D insurance and employer-paid LTD insurance
  Employees remain enrolled in dental, vision, basic life, basic AD&D, and employer-paid long-term disability (LTD) during approved PFML that is concurrent with FMLA.
• Supplemental Life and AD&D insurance
  Employees may choose to either continue or defer (pause) enrollment in supplemental life and AD&D for themselves and their dependents.
  • Option 1: Continue supplemental life and AD&D
    • Payroll deduction: If using accrued leave, continue to deduct employee premiums. If they do not use accrued leave, make arrangements with employees to prepay or pay-per-month for their premiums.
    • Direct billing: If employees receive direct billing from MetLife, they continue to submit premium payments directly to MetLife.
  • Option 2: Defer enrollment in supplemental life and AD&D
    • To defer enrollment, employees must complete and submit the MetLife Cancellation of Supplemental Life Insurance form to MetLife.
    • When returning to work:
      • Employees must complete and submit the MetLife Enrollment/Change form to their benefits administrator.
      • The employer must submit the MetLife Notification of Enrollment Extension form and the employee's enrollment/change form to MetLife to reinstate the amount of supplemental life and AD&D insurance they had prior to going on leave, without requiring evidence of insurability (EOI).

Life and AD&D insurance premium waiver and accelerated life benefit

Employees may be eligible for a waiver of their life and AD&D insurance premiums, or the accelerated life benefit. Advise employees or their representatives to contact MetLife customer service for more information: 1-866-548-7139. Learn more about life and AD&D insurance.

• Employee-paid LTD insurance
  During the first 90 days of an approved leave of absence, employee-paid long-term disability (LTD) insurance is continued, but LTD premium payments are waived. Leave the employee enrolled in employee-paid LTD but waive the premiums in Benefits 24/7.
• Employees have two options following the 90-day premium waiver:
  • Option 1: Continue employee-paid LTD
    • Beginning on day 91, employee-paid LTD premiums must be reinstated.
    • Payroll deduction: If using accrued leave, deduct employee premiums. If accrued leave is not used, make arrangements with employees to prepay or pay-per-month for their premiums.
  • Option 2: Discontinue employee-paid LTD
    • To discontinue employee-paid LTD, employees must complete and submit the LTD Enrollment/Change form to their benefits administrator.
    • When returning to work:
      • Employees will be eligible to reinstate the same employee-paid coverage level (50% or 60%) that was in effect prior to leave, without providing EOI.
      • To reinstate coverage, employees must complete and submit the LTD Enrollment/Change form to their benefits administrator.

Visit the forms and publications webpage for manuals to find instructions on how to process changes in Benefits 24/7 and see the LTD Administration manual to learn more.

Pro tip!

LTD claims should be filed as soon as the employee's last day (physically) on the job is known, if applicable. Do not wait for the 90-day waiting period or leave to be exhausted to file the claim. Learn how to file an LTD claim.

• FSA or Limited Purpose FSA
  Employees of state agencies and higher ed have the option to continue or discontinue participation in a PEBB FSA or Limited Purpose FSA.
  • Option 1: Continue participating in an FSA
    • Payroll deduction: If using accrued leave, continue to deduct employee contributions. If accrued leave is not used, make arrangements with employees to prepay their contributions.
      • To prepay the contribution, employees must complete and submit Navia's Change in Status form to their benefits administrator before going on approved leave.
  • Option 2: Discontinue participating
    • Employees must complete and submit Navia's Change in Status form to their benefits administrator.

When returning to work, employees must complete and submit Navia's Change in Status form to their benefits administrator no later than 60 days after the date they returned to work.

Employees have two options when resuming participation in an FSA:

• Option 1: Resume participation at the same coverage level by increasing the per-pay-period contribution for the balance of the plan year.
• Option 2: Resume participation at a reduced coverage level by continuing the same per-pay-period contribution for the balance of the plan year.

When approved PFML that is concurrent with FMLA ends

Employees who exhaust the period of leave approved under PFML that is concurrent with FMLA will lose eligibility for the employer contribution, unless they meet the criteria to maintain eligibility, or they return to work.

Active military duty for less than 31 days

Maintaining eligibility for PEBB benefits when called to active military duty for less than 31 days

Eligible employees called to active military duty in the uniformed services, as defined under the Uniformed Services Employment and Reemployment Rights Act (USERRA), for less than 31 days are eligible for the employer contribution (RCW 73.16.053). To comply with this rule, employers must maintain-employer provided coverage until the end of the month in which the 31 days occurs.

For example, if the employee is called to active military duty on September 15, PEBB benefits should be maintained until October 31.

Leave the employee (and their dependents) enrolled in Benefits 24/7. If using accrued leave, continue payroll deduction. If the employee is not using accrued leave, make arrangements with employees to prepay or pay-per-month for their premiums.

Active duty and waiving PEBB medical coverage

If employees have a qualifying SOE event due to being called to active military duty (e.g., will receive TRICARE coverage while serving in the military), they may be able to waive their PEBB medical coverage. Employees who waive medical must remain enrolled in PEBB dental, vision, basic life, basic AD&D, and employer-paid LTD. See the SOE matrix: Addendum 45-2A to learn more.

After 31 days, employees will lose eligibility for the employer contribution, unless they meet the criteria to maintain eligibility, or they return to work.

Loss of eligibility while on approved leave

Eligibility for the employer contribution toward PEBB benefits ends when employees no longer meet the criteria to maintain eligibility. When employees lose eligibility:

1. Terminate their PEBB coverage in Benefits 24/7, effective the last day of the month in which they lost eligibility.
   • Visit the forms and publications webpage for manuals to find instructions on how to process changes in Benefits 24/7.
   • If terminations are not processed timely in Benefits 24/7 it may affect employee or dependent options to continue coverage and the employer's financial responsibility. See PEBB Policy Addendum 19-1A for more information.

This table describes when employee benefits end following a loss of eligibility.

Options for continuing PEBB coverage while on approved leave

Employees who lose eligibility while on approved leave may:

• Continue medical, dental and vision coverage for up to 29 months on a self-pay basis by enrolling in PEBB Continuation Coverage (Unpaid Leave). (WAC 182-12-131 and 182-12-146).
  • If called to active military duty, employees may also continue life and AD&D insurance up to 29 months after active duty began.
  • If on approved educational leave or called to active military duty, employees may also continue LTD insurance for up to 29 months.

• Continue their participation in an FSA by paying their contributions directly to Navia on a post tax basis. There are no continuation coverage options for the DCAP. Contact Navia for more information.

Learn about PEBB Continuation Coverage (COBRA) and what is required to enroll.

Returning to work after approved leave

Employees who maintain eligibility for the employer contribution toward PEBB benefits during an approved leave of absence, remain enrolled upon returning to work in an eligible position.

Employees who lost eligibility while on approved leave (except active military duty), regain eligibility when they return to work and are in pay status 8 or more hours in a month, or 5% of full-time for faculty.

Employees who lost eligibility while on active military duty, as defined by USERRA, regain eligibility the day they return from active duty (WAC 182-08-197).

The table below describes what forms are required and when employee benefits begin after returning from leave.

Exception for employees who are appealing a dismissal

When appealing a dismissal, employees whose appeal is approved and their coverage is reinstated, all supplemental life, AD&D, and employee-paid LTD insurances in force at the time of dismissal will be reinstated retroactively only if the employee makes retroactive payment of the premium for any such coverage, which was not continued by self-payment during the appeal process.

If the employee chooses not to pay the retroactive premium, evidence of insurability will be required to restore supplemental and employee-paid coverages (WAC 182-12-148(5)(b)).

If the dismissal is upheld and the employee is eligible for PEBB Continuation Coverage (COBRA), they may continue medical and dental for the remaining months available under COBRA. The number of months they self-paid premiums during the appeal process will count toward the total number of months allowed under COBRA (WAC 182-12-148(4)). Learn more about PEBB Continuation Coverage (COBRA).

Employees may also be eligible to continue their FSA under COBRA. There are no continuation coverage options for the DCAP. Contact Navia for more information.