Due to COVID-19, HCA’s lobby is closed. Learn more about your customer service options.
Electing Leave Without Pay (self-pay) coverage and returning to work
General information and requirements
- Employees experiencing one of the events listed below and electing Leave Without Pay (Self-Pay) coverage, or,
- 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.
- 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
- 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:
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).
|Long Term Disability (LTD)||Employer:
|Medical Flexible Spending Arrangement (FSA)||Employer:
- Eligibility Manual
- Special Open Enrollment Guidance (Policy 45-2, Addendum 45-2A)
- Loss of Eligibility (Policy 19-1, Addendum 19-1A)
- Lower Limit and Current Process Calendar: 2020 | 2021
- Declaration of Tax Status: 2021
- Continuation Coverage Election Notice
- Employee Enrollment/Change: 2021
- MetLife Enrollment/Change
Premium surcharge attestations
- Premium Surcharge Change form: 2021 (for current employees)
- Premium Surcharge Help Sheet: 2021
- Spousal Plan Calculator: 2021 (print version)
- 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
- 182-08-015 - Definitions
- 182-08-180 - Premium payments and refunds
- 182-08-190 - The employer contribution for all eligible employees
- 182-08-198 - Changing health plans
- 182-08-199 - Enroll in or change election amount for FSA
- 182-12-109 - Definitions
- 182-12-129 - Employee moves from an eligible to ineligible position or job due to layoff.
- 182-12-131 - How do eligible employees maintain the employer contribution toward insurance coverage?
- 182-12-133 - Options available to employees on certain types of leave or whose work ends due to layoff.
- 182-12-136 - May an employee on approved educational leave waive PEBB health plan coverage?
- 182-12-262 - Enroll, waive or remove eligible dependents