PEBB Continuation Coverage (COBRA)

The Health Care Authority administers PEBB Continuation Coverage (COBRA), a temporary extension of PEBB medical and/or dental coverage, for eligible members (employees and dependents) who lose eligibility for the employer contribution toward PEBB benefits.

Employees may qualify for PEBB Continuation Coverage (Unpaid Leave), which may allow a longer coverage period and additional benefits. 

Continuation coverage eligibility and enrollment timelines are extended due to COVID-19 through an emergency resolution

The Health Care Authority (HCA) is responsible for verifying that all enrollees are notified of their continuation coverage rights within the required time frame. To satisfy this requirement, the HCA has assumed the responsibility for distributing continuation coverage materials, including the:

Who is eligible for COBRA? 

Each member (employee or dependent) who loses their PEBB health plan coverage due to a qualifying event has an independent right to elect to continue medical coverage, dental coverage, or a combination of both by enrolling PEBB Continuation Coverage (COBRA) on a self-pay basis. 

For example, if an employee loses their PEBB employer-based group health plan due to a qualifying event, their eligible spouse or state-registered domestic partner (SRDP) may choose continuation coverage, even if the employee does not. Either the employee or their spouse or SRDP may choose continuation coverage for any dependent children.

Qualifying events

A qualifying event is a life event that causes loss of coverage.

Examples of qualifying events for an employee are: 

  • Employment ending for any reason other than gross misconduct.
  • Hours of employment are reduced below the number of hours required to be eligible for the employer contribution toward PEBB benefits. 
    • Eligibility is maintained when the employee is in pay status of eight or more hours per month (or 5% for faculty).

Examples of qualifying events for a spouse or state-registered domestic partners (SRDPs) are:

  • The employee dies. The surviving spouse/SRDP may qualify for COBRA or PEBB retiree insurance coverage.
  • The employee's hours of employment are reduced below the number of hours required to be eligible for the employer contribution toward PEBB benefits.
  • The employee's employment ends for any reason other than gross misconduct.
  • They and their spouse (the employee) have experienced a divorce, annulment, or dissolution of marriage.
  • Their state-registered domestic partnership (with the employee) ends.

Examples of qualifying events for dependent children are:

  • The parent (employee) dies.
  • The employee's hours of employment are reduced below the number of hours required to be eligible for the employer contribution toward PEBB benefits.
  • The employee's employment ends for any reason other than gross misconduct.
  • Eligibility for PEBB benefits as a dependent child ends.

How do eligible PEBB members enroll in COBRA?

To continue PEBB medical and/or dental coverage by enrolling in COBRA, the member (employee or dependent) must complete and return the PEBB Continuation Coverage (COBRA) Election/Change form along with the first premium payment to the PEBB Program.

The PEBB Program must receive the:

  • Required form and supporting documentation (if applicable) no later than 60 days after PEBB benefits end or from the postmark date on the PEBB Continuation Coverage Election Notice, whichever is later.
  • First premium payment, including applicable premium surcharges, are due to the HCA/PEBB Program no later than 45 days after the 60-day election period ends. Explore plan costs on the PEBB Continuation Coverage website.

Enrollment will not be processed until the required form and first premium payment have been received (within the required time frames). 

When an employee's or dependent's PEBB coverage/benefits is terminated, the PEBB Program will mail the PEBB Continuation Coverage Election Notice to them no later than 14 days after their coverage has been terminated. 

Learn more about when eligibility for benefits ends

When does coverage under COBRA begin? 

If elected, medical and/or dental benefits under PEBB Continuation Coverage begin the first day of the month following the date PEBB benefits as an eligible employee or dependent ended. 

For example, if PEBB benefits as an eligible employee or dependent end on September 30, coverage under COBRA will begin October 1. 

How long does coverage under COBRA last?

The maximum coverage period for COBRA can last anywhere from 12 to 36 months and is determined by the qualifying event that caused the employee or dependent to lose eligibility for the employer contribution toward PEBB benefits. In some situations, coverage under COBRA can end before the maximum coverage period.

A detailed explanation of the maximum coverage periods for each qualifying event is available on the PEBB Continuation Coverage website.

Continuing life insurance under portability or conversion

PEBB Continuation Coverage (COBRA) subscribers who are eligible and wish to continue life insurance under portability or conversion must complete and submit the form sent to them by MetLife after their PEBB benefits were terminated. MetLife must receive the form no later than 60 days after PEBB employee life insurance ends.

Learn more about portability and conversion options for continuing life insurance

Continuing participation in a Flexible Spending Arrangement

Employees of state agencies and institutions of higher education or their dependents may be eligible to continue participating in their Flexible Spending Arrangement (FSA) until the end of the plan year if a qualifying event occurs by contacting Navia Benefit Solutions

If eligible, Navia will mail a COBRA election notice to the employee or dependent. Navia must receive their election no later than 60 days from the date their PEBB benefits ended or the postmark date on Navia's COBRA election notice, whichever is later.

Find more information in the PEBB Medical Flexible Spending Arrangement Enrollment Guide on Navia's website.

Related rules and policies

 

Contact

The PEBB Program
Members should contact the PEBB Program directly for questions related to PEBB Continuation Coverage and PEBB Retiree Insurance. 
Phone: 1-800-200-1004 
TRS: 711

MetLife 
Online: MetLife MyBenefits
Phone: 1-866-548-7139

Navia Benefit Solutions
Online:
 Navia Benefit Solutions
Email: customerservice@naviabenefits.com
Phone: 1-800-669-3539