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Electing Leave Without Pay (self-pay) coverage and returning to work

General information and requirements

Updated 3/2020

Applicable to

  1. Employees experiencing one of the events listed below and electing Leave Without Pay (Self-Pay) coverage, or,
  2. Employees who have returned to work from one of the listed events below and are in pay status for 8 or more hours during a calendar month.

Events

  • Employees on authorized leave without pay from agency
  • Employees laid off due to an employer's lack of funds or an employer's organizational change
  • Employees receiving time-loss benefits under workers' compensation
  • Employees called to active military duty (USERRA)
  • Employees on approved educational leave
  • Employee applying for disability retirement

Relevant rule

  • Employees and their covered eligible dependents may continue benefits by applying for Leave Without Pay (LWOP) coverage during an absence from work. Benefits that may be continued include any combination of medical, dental, and life insurance (WAC 182-12-133). Employees on approved educational leave or called to active military duty (USERRA) may continue basic and optional LTD insurance for up to 29 months by paying the required monthly premium (WAC 182-12-133).
  • Employees who have returned to work from one of the listed events above and who have obtained 8 or more hours of pay status during a calendar month may be eligible for the employer contribution toward benefits (WAC 182-08-190).

    Note: Employees returning from layoff must meet the requirements of WAC 182-12-129.

  • Employees on Family Medical Leave (FMLA) who do not self-pay optional life during their FMLA leave will have that level of coverage reinstated without statement of health upon their return.
  • An employee who self-paid for optional life insurance coverage after losing eligibility will have that level of coverage reinstated without statement of health. An employee who was eligible to continue optional life under continuation coverage but discontinued that insurance coverage must submit statement of health upon regaining eligibility for the employer contribution to reinstate coverage.
  • An employee who was eligible to continue optional LTD under continuation coverage but discontinued that insurance coverage must submit evidence of insurability for optional LTD insurance when he or she regains eligibility for the employer contribution. An employee's optional LTD insurance will be automatically reinstated when the employee continued to self-pay their optional LTD insurance or if the employee was not eligible to continue optional LTD insurance after losing eligibility for the employer contribution.
  • PEBB benefits should be continued for employees called to active military service for less than 31 days. For administrative efficiency in complying with the rule, agencies should maintain employer-provided coverage until the end of the month in which the 30 days occurs. For example, if the employee was called to active military service on September 15th, employer health care coverage should be maintained until October 31st (RCW 73.16.053).
Benefit... ...going out on approved LWOP... ...returning to work
Medical and dental Employer:
  1. Complete C-1 worksheet (Approved Leave) or C-7 worksheet (Layoff).
  2. Terminate benefits in the PAY1 insurance system immediately after the date employment ends or as soon as the employee's end date is known.
  3. For the termination effective date for all employees (except employees called to active military service), refer to termination due to loss of eligibility Policy 19-1, Addendum 19-1A.
  4. Military Duty:
    1. For employees called for less than 31 days, the termination date would be the end of the month in which the 30 days occurs (RCW 73.16.053).
    2. For employees called for 31 days or more, refer to Policy 19-1, Addendum 19-1A for the termination date.

    Employee:

    1. May self-pay to HCA for the same medical and dental plan they were covered under the day before going out on LWOP.
    2. Subscriber and dependents will have an independent right to choose coverage and may choose different options.
    3. Options include:
      1. Medical only
      2. Medical and dental
      3. Dental only
    4. The employee may choose to change medical and/or dental plans at the time they apply for self-pay due to the special open enrollment event. Employees may also change plans during annual open enrollment.
    5. Dependents who enroll in medical and/or dental coverage will be enrolled in the same plans as the employee.
    6. LWOP Continuation Coverage Election form must be received no later than 60 days after the postmark date on the Continuation of Coverage Election Notice.
    7. The employee must make the first payment for continuation of coverage no later than 45 days after the date coverage was elected. (This is the date the election form is received by HCA.) Or:
      1. Employees who have a spouse or state-registered domestic partner also covered by PEBB benefits may enroll under the spouse or state-registered domestic partner's medical and/or dental coverage as a dependent.
      2. A new Employee Enrollment/Change form must be completed and turned into the spouse or state-registered domestic partner's personnel/payroll/benefits office no later than 60 days after the employee lost eligibility for the employer contribution.
Employer:
  1. Complete D-1 worksheet (Returning from LWOP) or D-2 worksheet (Returning from Layoff).
  2. Check the PAY1 insurance system or inquire through FUZE to see if the employee paid and continued coverage through HCA Continuation of Coverage (LWOP).
  3. If the employee self-paid, provide HCA the date the employee returned to work.
  4. The effective date for coverage will be the first of the month in which the employee returned to work with at least 8 hours of pay status.
    Note: Employees returning from layoff must meet the requirements of WAC 182-12-129.
  5. The employee must complete the required forms indicating his or her enrollment elections, including an election to waive PEBB medical if the employee chooses to waive PEBB medical. Forms must be received no later than 31 days after the employee regains eligibility.

If the employing agency does not receive the required forms within 31 days of the employee regaining eligibility, default the employee to Uniform Medical Plan, Uniform Dental Plan, basic life, basic LTD, and the tobacco use premium surcharge as a single subscriber (no dependents enrolled).

Employee:

  1. Regains eligibility for the employer contribution with 8 or more hours of pay status when returning to work.
Life Insurance Employer:
  1. No action required.

Employee:

  1. May self-pay to MetLife.
  2. May choose to continue all or part of the life insurance coverage.
Employee:
  1. Regains eligibility for employer contribution with 8 or more hours of pay status when returning to work from LWOP.
  2. The employee must submit the MetLife Enrollment/Change form no later than 31 days after regaining eligibility, even if they self-paid their coverage. If MetLife does not receive the required form within 31 days of the employee regaining eligibility, the employee will be defaulted to basic life only and must submit statement of health to reinstate prior coverage.
  3. An employee who self-paid for optional life insurance coverage after losing eligibility will have that level of coverage reinstated without statement of health. An employee who was eligible to continue optional life under continuation coverage but discontinued that insurance coverage must submit statement of health upon regaining eligibility for the employer contribution to reinstate coverage.
Long Term Disability (LTD) Employer:
  1. No action required. PAY1 will automatically terminate LTD coverage when you enter the coverage end date in step #1 of the "medical and dental" section above.

Employee:

  1. Self-pay of LTD coverage is only an option for employees on approved educational leave or when called to active military duty (USERRA).
Employer:
  1. Reinstate coverage in place prior to the employee going out on LWOP.
  2. Effective date for optional coverage will be the first of the month following the date the employee is in pay status eight or more hours.
  3. For educational and military (USERRA) leave employees who self-paid, the effective date will be the first of the month in which the employee returns to work. For educational and military leave employees who did not self-pay, the employee must reapply and provide evidence of insurability for carrier approval to reinstate optional LTD coverage.

Employee:

  1. Regains eligibility for employer benefits with 8 hours of pay status when returning to work from LWOP status. Employees on educational and military leave (USERRA) who did not self-pay for optional LTD while on leave must reapply and submit evidence of insurability reinstate optional LTD.
Medical Flexible Spending Arrangement (FSA) Employer:
  1. Contact Navia Benefit Solutions of the employee's start and end date (if known) of leave.

Employee:

  1. Employees using at least 8 hours of pay status may continue contributions through payroll deduction. Employees not using at least 8 hours of pay status may be eligible to continue the Medical FSA through continuation of coverage or by submitting the contribution directly to Navia Benefit Solutions by contributing monthly or prepaying the contribution.
  2. If the employee has a spouse or state-registered domestic partner also covered by PEBB benefits, the spouse or state-registered domestic partner may change their election.
Employer:
  1. Verify that contributions were paid for the period in which the employee was on LWOP by contacting Navia Benefit Solutions or reviewing agency payroll records.
  2. If contributions were paid for the period the employee was on LWOP, continue deductions at the same per-paycheck deduction.
  3. If the employee did not continue paying contributions for the coverage, do not continue coverage. The employee may not be eligible.
    Note: Different rules apply to employees on FMLA or Military Leave. Contact Navia Benefit Solutions for coverage rules and options.

Employee:

  1. Continues paying premium, if eligible.
  2. If not eligible to continue coverage, employee can reapply during annual open enrollment for the next plan year.

Guidance resources

Forms

Premium surcharge attestations

  • Premium Surcharge Change form: 2021 (for current employees)
  • Premium Surcharge Help Sheet: 2021
  • Spousal Plan Calculator: 2021 (print version)

Rates

  • Life/ADD, and LTD Insurance: 2021
  • Active Employees: 2021 (state agency and higher education institution employees)

System keying in PAY1

WAC references and their general subject matter