FAQs for PEBB benefits administrators

Are there health insurance options outside of the PEBB Program?

The Marketplace offers private health insurance options. In Washington State, private health insurance plans can be accessed through the Washington Health Benefit Exchange. Employees can find out if they're eligible for a tax credit that lowers their monthly premiums and out-of-pocket costs for deductibles, coinsurance, and copays. They'll also learn if they qualify for free or low-cost coverage from Medicaid (called Apple Health in Washington State), the Children’s Health Insurance Program (CHIP), or Cascade Care plans.

Coverage through the Washington Health Benefit Exchange may cost less than PEBB Continuation Coverage. Being offered PEBB Continuation Coverage won’t limit one's eligibility for coverage or for a tax credit through the Marketplace. Find out more about plans offered under the Washington Health Benefit Exchange at Washington Healthplanfinder.

Can an eligible PEBB employee waive medical to remain enrolled on someone else’s (i.e. spouse, SRDP or parent’s) COBRA coverage?

No, an employee cannot waive enrollment in medical to be on someone else’s COBRA medical coverage. An employee may waive enrollment in medical if they are enrolled in other employer-based group medical, a TRICARE plan, or Medicare Part A and B.  "Employer-based group medical" is defined as group medical related to a current employment relationship and does not include COBRA coverage.

During the layoff process, what happens to an employee's PEBB benefits?

To keep eligibility for the employer contribution toward PEBB benefits, an employee must have at least eight hours of pay status in each month. Typically, one full day of work or a full day of paid leave (vacation or sick leave) covers this requirement.

However, if the employee cannot maintain at least eight hours of pay status in a PEBB benefits-eligible position, then their insurance coverage (and insurance coverage for any enrolled dependents) will end on the last day of the month in which they are in pay status for at least eight hours.

If their coverage ends, the employee would be eligible to continue any combination of medical, dental, vision, life insurance, and accidental death and dismemberment (AD&D) insurance under PEBB Continuation Coverage (Unpaid Leave) for up to 29 months, as described in WAC 182-12-133. The employee would be responsible to self-pay the full monthly premium and applicable premium surcharges. The PEBB Program will mail the employee a booklet that describes this option and includes the enrollment form. Learn more about PEBB Continuation Coverage (Unpaid Leave).

If the affected employee has a spouse or state-registered domestic partner who is eligible for benefits with their employer (including PEBB or SEBB), they may enroll as a dependent under their account through a special open enrollment. 

If the federal government shuts down and impacts a PEBB benefits‐eligible employee, what will happen to their PEBB benefits? If they have a medical procedure during the shutdown, will it be covered?

To keep eligibility for the employer contribution toward PEBB benefits, an employee must have at least eight hours of pay status in each month (WAC 182‐12‐131). WAC 182‐12‐109 defines pay status as “all hours for which an employee receives pay.” Typically, one full day of work or a full day of paid leave (vacation or sick leave) covers this requirement. If an employee is not able to work or submit leave for at least eight hours in a month, they will lose eligibility for the employer contribution toward their PEBB benefits; coverage will end on the last day of that month for the employee and any enrolled dependents.

If this happens, the affected employee and their dependents may continue any combination of medical, dental, or vision and may also continue life insurance and accidental death and dismemberment (AD&D) insurance by self-paying the premiums and applicable premium surcharges on a post-tax basis. This is called PEBB Continuation Coverage. Employers make no contribution toward the premiums.

When coverage ends, the PEBB Program will mail a PEBB Continuation Coverage Election Notice booklet to the employee. This booklet describes  available options continuing PEBB insurance coverage.

The PEBB Program offers two types of continuation coverage: PEBB Continuation Coverage (COBRA) and PEBB Continuation Coverage (Unpaid Leave). If an employee loses coverage due to a government shutdown, it would likely be to their advantage to elect PEBB Continuation Coverage (Unpaid Leave) because:

  • This coverage also includes the option to continue life insurance. COBRA offers portability or conversion options for life insurance.
  • This coverage lasts up to 29 months for a layoff. COBRA generally lasts up to 18 months for a termination or a reduction in hours.

Neither option allows the employee to continue either employer-paid long‐term disability insurance or employee-paid LTD insurance due to a layoff or a reduction of hours.

When enrolling in PEBB Continuation Coverage (COBRA or Unpaid Leave), the employee must pay the full monthly premium and any applicable surcharges. The premiums for both options are the same. Premiums can be found in the PEBB Continuation Coverage Election Notice and on the PEBB Program webpage under "Explore costs."

To enroll in PEBB Continuation Coverage (COBRA or Unpaid Leave), the PEBB Program must receive the affected employee's request in Benefits 24/7 or forms and supporting documentation no later than 60 days after their PEBB health plan coverage ends or from the postmark date on the PEBB Continuation Coverage Election Notice, whichever is later.

If the affected employee has a medical procedure during the shutdown, will it be covered?

If the PEBB Program receives the completed enrollment, monthly premium(s), and any applicable surcharge(s) within the timelines stated in the notice, the employee will continue to receive health plan coverage for any covered services they receive during the shutdown. Their PEBB Continuation Coverage (COBRA or Unpaid Leave) will automatically end when they regain eligibility for the employer contribution toward PEBB benefits.

What happens to an employee's health savings account (HSA) during a layoff?

The HSA still belongs to the employee; however, the employer no longer contributes to it when employment ends.

If eligible, the employee can elect to continue enrollment in their Consumer-Directed Health Plan (CDHP) through PEBB Continuation Coverage (Unpaid Leave) and use their HSA dollars to pay for health insurance premiums and health care expenses. They can also continue to use their HSA for health care expenses even if they do not have other coverage.

Note: HealthEquity may charge the employee a monthly fee if they maintain their HSA without being enrolled in a PEBB CDHP. Employees can learn more in The Complete HSA Guidebook, or by contacting HealthEquity, the HSA administrator, toll-free at 1-877-873-8823 (for Kaiser members) or 1-844-351-6853 (for UMP members).

Where can benefits administrators and employees learn about PEBB Continuation Coverage?

Benefits administrators (BAs) and employees can review the current PEBB Continuation Coverage Election Notice and visit the PEBB Continuation Coverage section of the Employee and retiree benefits website to learn about eligibility and enrollment requirements.

Information about continuation coverage is also available to BAs on the PEBB BA website.

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