Newly eligible employees

Information about the requirements and processes for enrolling employees who become newly eligible for the employer contribution toward Public Employees Benefits Board (PEBB) benefits.

Review the Covid-19 notices for guidance related PEBB eligibility.

Employee eligibility for the employer contribution toward PEBB benefits is determined in accordance with Title 182 WAC and any additional policies, procedures, or written guidance issued by the PEBB Program. 
However, employer groups may have different eligibility criteria, if approved by the PEBB Program (PEBB Policy 90-3). Any approved criteria will be outlined in Appendix A of your organization's Interlocal Agreement.

Providing notice of the determination of eligibility

Employers must provide written notice of the determination of eligibility (or ineligibility) to an employee upon hire and when an employee experiences a change in eligibility. The notice should be provided within a reasonable time frame as part of the hiring process.

Learn about providing notification of eligibility for state agencies and institutions of higher education or for employer groups.

Enrollment requirements

All newly eligible employees must complete and submit required enrollment forms and dependent verification (if applicable), to their payroll or benefits office no later than 31-days after becoming eligible for PEBB benefits (WAC 182-12-197). However, an employee eligible for PEBB benefits must have no less than ten calendar days after the date of receiving notice of eligibility to elect benefits (PEBB Policy 11-1).

Enrollment forms must be submitted, even if an employee chooses to waive PEBB medical.

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. 

Enrollment forms

PEBB enrollment forms and educational materials are available on the Forms and publications page. 

Eligible employees must complete and submit the following forms to their payroll or benefits office for processing:

PEBB Employee Enrollment/Change form*

For all eligible employees, except medical-only groups.

  • Required for making medical and dental elections, enrolling eligible dependents, and attesting to the premium surcharges (if applicable).

PEBB Employee Enrollment/Change for Medical-only Groups form

For eligible employees of medical-only groups.

  • Required for making medical elections, enrolling eligible dependents, and attesting to the premium surcharges (if applicable).

Long-term Disability Enrollment/Change form*

For all eligible employees, except medical-only groups.

  • 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**

For employees of state agencies and higher-education institutions only.

  • 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.

The following forms are submitted by the employee directly to MetLife for processing:

MetLife Enrollment/Change form*

For all eligible employees, except medical-only groups.

  • Required for making supplemental life and accidental death & dismemberment (AD&D) insurance elections and adding beneficiaries.

MetLife Beneficiary Designation form*

For all eligible employees, except medical-only groups.

  • For adding or updating beneficiaries only.

*Employees may use MetLife’s MyBenefits portal to add beneficiaries and/or elect supplemental insurance coverages instead of completing a paper form. Learn more on the Life and AD&D page.

Adding eligible dependents

Employees who wish to enroll eligible dependents in their PEBB medical and/or dental coverage must submit valid dependent verification to their payroll or benefits office no later than 31-days after the date the employee becomes newly eligible or regains eligibility.

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

The informative worksheets contain:

  • A list of eligible dependents,
  • A list of valid verification documents,
  • The process to add dependents to PEBB benefits for employees, and
  • Guidance for processing dependent verification for benefits administrators.

Additional forms may be required to enroll eligible dependents.

If the required forms and verification documents are not received by the deadline, dependents cannot be enrolled until next annual open enrollment, or a special open enrollment event occurs that allows for the enrollment of a dependent (WAC 182-12-262).

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).

If dual enrollment exists, and action is not taken to resolve dual enrollment, the programs will automatically enroll or disenroll an individual as described in WAC 182-12-123(6).

Learn about the steps to take when you encounter dual enrollment.

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 window (WAC 182-12-123):

  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. Learn more about waiving PEBB medical coverage

Employees must enroll in dental, basic life insurance, basic AD&D insurance, and employer-paid LTD insurance under their own account through their employer, even if PEBB medical is waived. Employees will also be enrolled in employee-paid LTD insurance unless they decline the coverage (WAC 182-12-128). This does not apply to employees of PEBB participating medical-only employer groups.

Dual eligibility in the PEBB and SEBB Programs

Employees eligible for the employer contribution toward PEBB benefits and 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 must enroll in basic life insurance, basic AD&D insurance, and employer-paid LTD insurance under both employers. Employees will also be enrolled in employee-paid LTD insurance unless they decline the coverage (WAC 182-12-128). This does not apply to employees of PEBB participating medical-only employer groups.

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

PEBB eligible employees who are also eligible for SEBB benefits as a dependent (dual eligibility), may choose one of the following options during an eligible enrollment window (WAC 182-12-123):

  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. Learn more about waiving PEBB medical coverage

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.

Waiving medical coverage

Employees may waive enrollment in PEBB medical no later than 31-days after becoming newly eligible for PEBB benefits only if they are enrolled in other employer-based group medical (including PEBB or SEBB), a TRICARE plan, or Medicare (WAC 182-12-128).

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

To waive PEBB medical, employees must complete and submit the appropriate PEBB Employee Enrollment/Change form to their payroll or benefits office by the deadline.

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 accidental death and dismemberment (AD&D) insurance, and
  • Employer-paid long-term disability (LTD) insurance.
    • Employees will also be enrolled in employee-paid LTD insurance unless they decline the coverage.
    • 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 employee-paid LTD must be changed to "ineligible" in the Pay1 insurance system.

*Exception: In addition to waiving PEBB medical, an employee may also waive enrollment in dental 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 page for more information.

Enrolling in PEBB medical coverage after waiving

Employees who waive PEBB medical, may return from waive 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 to enroll their dependents.
  6. Enroll the employee (and dependents, if applicable) in the PAY1 insurance system.
    1. If Outreach & Training keys for you, submit the required forms for processing.

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.

When forms are not received timely

If required forms are not received by the deadline, enroll the employee in PAY1 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 employee-paid LTD must be changed to "ineligible" in the Pay1 insurance system.

Employees of medical-only employer groups who do not submit forms by the deadline, must be defaulted in PAY1 as a single subscriber, enrolled in the Uniform Medical Plan Classic with the $25 monthly tobacco use premium surcharge. If Outreach & Training keys for you, notify us when forms have not been submitted timely.

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
    • 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 employee-paid LTD must be changed to "ineligible" in the Pay1 insurance system.
  • 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 begins at the beginning of the second consecutive quarter/semester (WAC 182-12-114(3)(c)(ii)).

Contact

Outreach and Training
Benefits administrators contact O&T for eligibility, enrollment, or billing related questions.
Phone: 1-800-700-1555
Secure messaging: HCA Support