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Correcting employer errors

Employers must correct enrollment errors as described on this page and in WAC 182-08-187 and Public Employees Benefits Board (PEBB) Program Administrative Policy 11-3.

Error correction guidelines

In most cases, when an employer/benefits administrator (BA) error has occurred it may be resolved by the BA directly in accordance with Public Employees Benefits Board (PEBB) Program rules and policies, if the correction can be made in the PAY1 insurance system by the lower limit date. However, if an error has occurred more than 60 days in the past, the BA must complete the error correction process.

Errors which may require error correction are:

  • Failure to timely notify an employee of their eligibility for public employee benefits board (PEBB) benefits and the employer contribution as described in WAC 182-12-113(2).
  • Failure to enroll an employee and their dependents in PEBB insurance coverage as elected by the employee if their elections were received timely.
  • Failure to enroll an employee in PEBB insurance coverage (default enrollment) as described in WAC 182-08- 197(1)(b).
  • Failure to accurately reflect an employee's premium surcharge attestation on the employee's account in the PAY1 insurance system.
  • Enrolling an employee or their dependent in PEBB insurance coverage when they are not eligible as described in WAC 182-12-114 or 182-12-260.
  • Providing incorrect information regarding PEBB benefits to an employee which the employee relied upon.

How do benefits administrators correct enrollment errors?

When an employer/BA error, which occurred more than 60 days in the past has been identified, BAs must follow the steps below to complete the error correction process:

  1. Draft a correction/recourse notice that which will be sent to the employee, following review and approval by the Health Care Authority's PEBB Program.
    • The notice must describe the error that occurred, how the error will be corrected, and the recourse options available to the employee. Recourse options available to the employee are (WAC 182-08-197(5)):
      • Retroactive enrollment in a PEBB health plan.
      • Reimbursement of claims paid.
      • Reimbursement of amounts paid by the employee or dependent for medical and dental premiums.
      • Reimbursement of amounts paid by the employee for the premium surcharges.
      • Other legal remedy received or offered.
      • Other recourse, upon approval by the authority
  1. Send the completed draft notice to Outreach & Training (O&T) for review by the PEBB Program.
  2. If the notice is approved, send the notice to the employee. The notice will allow the employee to request their own recourse.
    • The employee will have 31 days to review, complete, sign, and return the notice and all required documents to their employer.
  3. Once received, send the completed and signed copy of the notice and required documents to O&T in response to the same incident number used to submit the initial notice draft for review.
    • If the employee fails to return notice and required documents, this must be reported in response to the same incident number.
  4. The correction will be noted by the PEBB Program and enrollment will be completed in the PAY1 insurance system by:
    • O&T if the correction is retroactive, or
    • The employer, at the direction of O&T, if the correction is prospective.

Contact

Outreach & Training
Phone: 1-800-700-1555