Newly eligible employees

Enrollment requirements

Newly eligible employees must complete and submit their elections and dependent verification (if applicable), no later than 31-days after becoming eligible for PEBB benefits (WAC 182-12-197).

Note: Enrollment elections must be submitted, even if an employee chooses to waive PEBB medical.

How do newly eligible employees complete their enrollment?

Newly eligible employees must complete their enrollment online using Benefits 24/7. However, employees may instead choose to complete and submit the following applicable forms to their benefits administrator (BA) for processing.

Additional forms and educational materials are available to download on the Forms and publications webpage.

Medical, dental, vision, employee-paid LTD insurance, FSAs, and the DCAP

• PEBB Employee Enrollment/Change form*
  • This form is for all eligible employees, except medical-only groups and is required for making medical and dental elections (including waiving medical), enrolling eligible dependents, and attesting to the premium surcharges (if applicable).
• PEBB Employee Enrollment/Change form for medical-only groups
  • This form is for eligible employees of medical-only groups and is required for making medical elections, enrolling eligible dependents, and attesting to the premium surcharges (if applicable).
• Long-term Disability Enrollment/Change form*
  • This form is for all eligible employees, except medical-only groups and is required for electing to reduce or decline automatic enrollment in employee-paid long-term disability insurance at the 60% coverage level.
• PEBB Midyear Enrollment form**
  • This form is only for employees of state agencies and higher-education institutions and is only required if electing to participate in the PEBB Program’s Medical Flexible Spending Arrangement (FSA), Limited Purpose FSA, and/or Dependent Care Assistance Program.

* Pierce County, Washington State University, and University of Washington employees must enroll through Workday.
** Washington State University, and University of Washington employees must enroll through Workday.

Supplemental life and accidental death and dismemberment (AD&D) insurance

Eligible employees can use MetLife’s MyBenefits portal to elect supplemental life and AD&D insurance for themselves and their eligible dependents and to add their beneficiaries. However, employees may choose to complete and submit the MetLife Enrollment/Change form or the Beneficiary Designation form instead. Employees cannot make life or AD&D elections using Benefits 24/7.

Once completed, employees should submit the form directly to MetLife using the submission instructions on the form.

Notes:

• Employees may choose to elect supplemental life and AD&D insurance at any time. However, if they apply for supplemental life insurance after their 31-day eligibility period or outside of a special open enrollment period, MetLife must approve the request and evidence of insurability will be required.
• Basic and supplemental life and AD&D insurance do not apply to medical-only groups.

Learn more on the Life and AD&D webpage.

Flexible Spending Arrangements (FSAs) and Dependent Care Assistance Program (DCAP)

What if an employee is transferring from another PEBB employer?

Eligible employees who transfer from one PEBB employer to another without a break in benefits are not considered newly eligible and do not make new benefit elections. Their benefit elections remain the same with the new employer.

Note: A break in benefits is one full calendar month or more in which the employee does not receive the employer contribution toward PEBB coverage.

Employees enrolled in a Medical Flexible Spending Arrangement (FSA), Limited Purpose FSA, or the Dependent Care Assistance Program (DCAP) may continue participation if the employee is:

• Transferring from one state agency or institution of higher education to another, and
• The time between employments is 30 days or less, and
• Is within the current plan year.

To continue participation, the employee must submit the Agency Transfer form to their BA at the new employer. The form must be received no later than 31 days after the employee's first day of work with the new employer.

If the employee does not meet the above criteria, participation cannot be continued until the beginning of the next plan year.

Review the A5 worksheet to learn more.

Adding eligible dependents to coverage

Benefits administrators should provide the E-1 worksheet and E-2 worksheet to employees seeking to add dependents to PEBB benefits.

Employees adding eligible dependents to their PEBB medical and/or dental coverage must submit valid dependent verification (DV) documents before their dependents can be enrolled. Both the enrollment elections and DV must be received in Benefits 24/7 or by the BA as follows:

• When newly eligible: No later than 31 days after the date the employee becomes eligible for PEBB benefits.
• During annual open enrollment (OE): No later than the last day of OE.
• During a special open enrollment (SOE): Generally, no later than 60 days after the date of the event that created the SOE.

Additional forms may be required to enroll eligible dependents. Learn more on the Dependents webpage.

Dual enrollment

Eligible employees and dependents are limited to a single enrollment in medical, dental, and vision plans in either the PEBB Program or School Employees Benefits Board (SEBB) Program (WAC 182-12-123).

Dual eligibility in the PEBB Program

Employees eligible for the employer contribution toward PEBB benefits under more than one employer (dual eligibility) must choose to enroll in benefits under only one employer.

What if an eligible PEBB employee is also eligible for PEBB benefits as a dependent?

Eligible employees who are also eligible as a dependent under their spouse’s, state-registered domestic partner’s, or parent’s PEBB coverage (dual eligibility), may choose one of the following options during an eligible enrollment period:

1. Enroll in PEBB medical under their own account as an employee, or
2. Waive enrollment in PEBB medical under their own account and enroll in PEBB medical as a dependent, or
3. Waive enrollment in PEBB medical under their own account if they are enrolled in other employer-based group medical, a TRICARE plan, or Medicare.

*Employees who waive enrollment in PEBB medical for either of the reasons listed above must enroll in the following PEBB benefits under their own account through their employer:

• Dental,
• Basic life insurance,
• Basic AD&D insurance, and
• Employer-paid LTD insurance
  • Eligible employees will also be enrolled in employee-paid LTD insurance unless they decline the coverage (WAC 182-12-128).
  • Seasonal employees who work a season of less than nine months and Port Commissioners are not eligible for employee-paid LTD. These employees are eligible for employer-paid LTD but must be made ineligible for employee-paid LTD in Benefits 24/7.

*Note: The above requirement does not apply to employees of PEBB participating employer groups offering medical-only benefits to their eligible employees.

Learn more about waiving PEBB medical coverage.

Dual eligibility in the PEBB and SEBB Programs

What if an eligible PEBB employee is also eligible for SEBB benefits as an employee?

Employees eligible for the employer contribution toward PEBB benefits and School Employees Benefits Board (SEBB) benefits (dual eligibility) must choose to enroll in medical, dental, and vision under only one employer (PEBB or SEBB) and must waive these benefits with the other employer.

*Employees who are eligible for both PEBB and SEBB must enroll in the following benefits under both employers:

• Basic life insurance,
• Basic AD&D insurance, and
• Employer-paid LTD insurance.
  • Employees will also be enrolled in employee-paid LTD insurance unless they decline the coverage (WAC 182-12-128).
  • Seasonal employees who work a season of less than nine months and Port Commissioners are not eligible for employee-paid LTD. These employees are eligible for employer-paid LTD but must be made ineligible for employee-paid LTD in Benefits 24/7.

*Note: The above requirement does not apply to employees of PEBB participating employer groups offering medical-only benefits to their eligible employees.

What if an eligible PEBB employee is also eligible for SEBB benefits as a dependent?

Employees who are also eligible for SEBB benefits as a dependent (dual eligibility), may choose one of the following options during an eligible enrollment period:

1. Enroll in PEBB medical (with vision) and dental under their own account as an employee, or
2. Waive enrollment in PEBB medical and dental and enroll in SEBB medical, dental, and vision as a dependent, or
3. Waive enrollment in PEBB medical and dental under their own account if they are enrolled in SEBB vision and dental as a dependent and are enrolled in other employer-based group medical, a TRICARE plan, or Medicare.

*Employees who waive enrollment in PEBB medical for either of the reasons listed above must enroll in the following PEBB benefits under their own account through their employer:

• Basic life insurance,
• Basic AD&D insurance, and
• Employer-paid LTD insurance
  • Eligible employees will also be enrolled in employee-paid LTD insurance unless they decline the coverage (WAC 182-12-128).
  • Seasonal employees who work a season of less than nine months and Port Commissioners are not eligible for employee-paid LTD. These employees are eligible for employer-paid LTD but must be made ineligible for employee-paid LTD in Benefits 24/7.

*Note: The above requirement does not apply to employees of PEBB participating employer groups offering medical-only benefits to their eligible employees.

Learn more about waiving PEBB medical coverage.

Employers pay the employer contribution when PEBB medical and dental are waived.

Employers must pay the employer contribution towards PEBB benefits as required in WAC 182-08-190(5), even if the employee chooses to waive PEBB medical and dental to enroll in SEBB medical, dental, and vision coverage. This does not apply to PEBB participating medical-only employer groups.

If dual enrollment occurs, and no action is taken to resolve dual enrollment during an eligible enrollment period, the programs will automatically enroll or disenroll an individual as described the Dual Enrollment Q&A for BAs and WAC 182-12-123(6).

Learn more about dual enrollment in Chapter 3 of the Benefits 24/7 manual.

Waiving medical coverage

Employees may waive enrollment in PEBB medical during the following timeframes if they are enrolled in other employer-based group medical (including PEBB or SEBB), a TRICARE plan, or Medicare (WAC 182-12-128):

• When newly eligible: No later than 31 days after the date the employee becomes eligible for PEBB benefits.
• During annual open enrollment (OE): No later than the last day of OE.
• During a special open enrollment (SOE): No later than 60 days after the date of the event that created the SOE.

Note: If an employee waives medical coverage for themselves, their dependents cannot be enrolled in medical.

Employees who waive enrollment in PEBB medical must enroll in the following PEBB benefits (this does not apply to medical-only groups):

• Dental*,
• Basic life insurance,
• Basic AD&D insurance, and
• Employer-paid LTD insurance
  • Eligible employees will also be enrolled in employee-paid LTD insurance unless they decline the coverage (WAC 182-12-128).
  • Seasonal employees who work a season of less than nine months and Port Commissioners are not eligible for employee-paid LTD. These employees are eligible for employer-paid LTD but must be made ineligible for employee-paid LTD in Benefits 24/7.

*In addition to waiving PEBB medical, an employee may also waive enrollment in dental only if they are enrolled in SEBB medical, dental and vision, or they are enrolled SEBB dental and vision and other employer-based group medical, a TRICARE plan, or Medicare. See the dual enrollment section on this webpage for more information.

How do employees waive medical coverage?

To waive PEBB medical, employees must complete and submit the appropriate PEBB Employee Enrollment/Change form to their BA by the required deadline.

Enrolling in PEBB medical coverage after waiving

Employees who waive PEBB medical coverage, may enroll in PEBB medical during annual open enrollment or if a qualifying special open enrollment event occurs.

Learn more about when employees may make changes.

Processing employee enrollment forms and documents

When required forms and documents are received by the deadline:

1. Date-stamp all documents with the date received.
2. Review forms for accuracy and completeness.
3. Complete the employer section of the Employee Enrollment/Change and LTD Enrollment/Change forms.
4. Remind employees that new forms supersede forms submitted in the past.
5. Remind employees that valid dependent verification documents are required before their dependents can be enrolled.
6. Enroll the employee (and dependents, if applicable) in Benefits 24/7.
   1. If Outreach and Training enters enrollment for you, submit the required forms for processing.

Note: If you receive an employee's MetLife enrollment form or Navia Midyear enrollment form, review the form(s) for completeness and return them to the employee. Instruct the employee to send the form(s) directly to the carrier using the instructions provided on each form.

What if enrollment forms are not received timely?

If required forms are not received or enrollment has not been completed in Benefits 24/7 by the deadline, enroll the employee in Benefits 24/7 as a single subscriber (no dependents enrolled) in the following default coverages (WAC 182-08-197 (1)(b)):

• Uniform Medical Plan Classic
  • With the $25 monthly tobacco use premium surcharge
• Uniform Dental Plan
• Basic life insurance
• Basic accidental death & dismemberment insurance
• Employer-paid long-term disability insurance
• Employee-paid (60%) long-term disability insurance
  • Seasonal employees who work a season of less than nine months and Port Commissioners are not eligible for employee-paid LTD. These employees are eligible for employer-paid LTD but must be made ineligible for employee-paid LTD in Benefits 24/7.

When benefits begin

For newly eligible employees (except faculty hired on a quarter/semester to quarter/semester basis), the following benefits begin the first day of the month following the day the employee becomes eligible for PEBB benefits. However, if the employee becomes eligible on the first working day of the month, benefits begin that day (WAC 182-12-114).

• Medical
• Dental
• Basic life insurance
• Basic AD&D insurance
• Employer-paid LTD insurance
• Employee-paid LTD insurance
  • Eligible employees will also be enrolled in employee-paid LTD insurance unless they decline the coverage (WAC 182-12-128).
  • Seasonal employees who work a season of less than nine months and Port Commissioners are not eligible for employee-paid LTD. These employees are eligible for employer-paid LTD but must be made ineligible for employee-paid LTD in Benefits 24/7.
• Flexible Spending Arrangement and/or Dependent Care Assistance Program
  • FSA/DCAP benefits are available to employees of state agencies and higher-education institutions only.

Supplemental life and AD&D insurance coverages begin on the first day of the month following the date MetLife receives the required form or approves the enrollment (WAC 182-12-114).

Faculty hired on quarter/semester to quarter/semester basis

For faculty hired on quarter/semester to quarter/semester basis, that the employer anticipates will not work for the entire instructional year or equivalent nine-month period, benefits begin the first day of the month following the beginning of the second consecutive quarter/semester of half-time or more employment.

If the first day of the second consecutive quarter/semester is the first working day of the month, then benefits begin at the beginning of the second consecutive quarter/semester (WAC 182-12-114(3)(c)(ii)).