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General information and requirements
- Employees and their covered dependents when the employee is laid off due to an employer's lack of funds or an organizational change.
- The employer must inform an employee in writing whether or not he or she is eligible for benefits and the employer contribution whenever there is a change in work patterns, such that the employee’s eligibility status changes (WAC 182-12-113).
- Employees who are no longer eligible for the employer contribution toward insurance coverage due to layoff may continue insurance coverage by self-paying the full premium set by HCA from the date the employer contribution is lost (WAC 182-12-133)(1)).
- The employer contribution toward PEBB benefits cease for employees and their enrolled dependents the last day of the month in which employees are eligible for the employer contribution. Exception: If the employing agency deducted the employee's premium for PEBB insurance coverage after the employee was no longer eligible for the employer contribution, PEBB insurance coverage ends the last day of the month for which employee premiums were deducted (WAC 182-12-131(7)).
- Employees who are laid off and are eligible to retire may choose to elect PEBB retiree coverage (WAC 182-12-171).
- Employees who return to another state agency or higher education institution position within 24 months may be eligible for the employer contribution toward benefits with eight or more hours of pay status per month (WAC 182-12-129 and WAC 182-12-131). The employee, upon hire, must notify the employing agency that he or she may be potentially eligible under WAC 182-12-129.
|Employer must...||...no later than...||...or this will happen|
|Complete Worksheet C-7 Layoff.||30 days after the date employment ends, or as soon as the employee’s end date is known.||Eligibility errors may occur and the employee will not receive the required notice and information about layoff provisions provided in the worksheet.|
|Terminate employee PEBB insurance coverage in PAY1.||Immediately after the date the employee loses eligibility for the employer contribution, or as soon as the employee's end date is known.||The Continuation of Coverage Election Notice will be delayed, resulting in increased employer cost for coverage, insurance coverage enrollment delays, and possible payment hardships. Refer to Termination Due to Loss of Eligibility (Policy 19-1, Addendum 19-1A) for more information.|
HCA will mail the Continuation of Coverage Election Notice to the employee after coverage is terminated in the insurance system. (This can take up to 14 days after insurance coverage is terminated in the PAY1 insurance system).
|Employees applying for self-pay must...||...no later than...||...or this will happen|
|Complete the PEBB Leave Without Pay (LWOP) Continuation Coverage Election form.||60 days after the postmark date of the Continuation of Coverage packet.||PEBB insurance coverage will end based on when the termination is keyed in the insurance system. Refer to the Termination Due to Loss of Eligibility (Policy 19-1, Addendum 19-1A) for more information.|
|Mail or hand-deliver the Leave Without Pay (LWOP) Continuation Coverage Election form to the PEBB program (address provided in packet).||60 days after the postmark date of the Continuation of Coverage packet||Employee will lose their right to continue coverage.|
|Choose to continue any optional life coverage that was in force as an active employee and pay the premium directly to MetLife.||60 days after the postmark date of the Continuation of Coverage packet.||Coverage that was reduced or not self-paid will require evidence of insurability when reapplying upon return to work.|
|Make the first full premium payment to HCA.||45 days after the date coverage is elected.||Employee will lose their right to continue coverage.|
|Employees who have...||...may...||...no later than|
|A spouse or state-registered domestic partner also eligible for employer-paid PEBB benefits.||Enroll under the spouse or state-registered domestic partner's medical and/or dental coverage as a dependent.||60 days after the date the employee lost eligibility for the employer contribution.|
|A Medical Flexible Spending Arrangement (FSA) through Navia Benefit Solutions.||Apply for Continuation of Coverage through Navia Benefit Solutions to extend their period of coverage, so that they may claim expenses incurred after employment ends.||60 days after the date the employee lost eligibility for the employer contribution.|
For spouse/domestic partner
Employees who have...
...the spouse/domestic partner may...
...no later than
A spouse or state-registered domestic partner also covered by PEBB benefits.
Enroll in or change their election through Navia Benefit Solutions for a Medical FSA.
60 days after the date the employee lost eligibility for the employer contribution.
*Medical FSA enrollment is available to state agencies and higher education employees only.
|Employees applying for PEBB retiree coverage must...||...no later than...||...or this will happen|
|Complete the PEBB-Sponsored Retiree Coverage Election form to enroll in or defer coverage.||60 days after employer-paid or COBRA coverage ends.||PEBB coverage will end on the last day of the month in which employment ends.|
|Mail, hand-deliver, or fax the election form to the PEBB program (address and fax number provided in the guide).||60 days after employer-paid or COBRA coverage ends.||Employee will lose their future right to enroll in PEBB retiree coverage.|
|Make the first full premium payment to HCA (if not electing pension deduction from Department of Retirement Systems).||45 days after electing coverage.||Employee will lose their future right to enroll in PEBB retiree coverage.|
*The employee may access the Retiree Enrollment Guide and enrollment forms on the PEBB website.
- Employees retiring under plans administered by the Department of Retirement Systems must contact DRS for information about retirement eligibility. Information is available at www.drs.wa.gov or by calling their toll-free number at 1-800-547-6657.
- The employee may contact HCA at 1-800-200-1004 to request a Retiree Enrollment Guide.
- Eligibility Manual
- Loss of Eligibility (Policy 19-1, Addendum 19-1A)
- Special Open Enrollment (Policy 45-2, Addendum 45-2A)
- Lower Limit and Current Process Calendar: 2020 | 2021
- Declaration of Tax Status: 2021
- PEBB Continuation Coverage Election Notice
- Employee Enrollment/Change: 2021
- MetLife Enrollment/Change
(or enrollment on the MetLife MyBenefits portal at www.metlife.com/wshca)
Premium surcharge attestations
- Premium Surcharge Change form: 2021 (for current employees)
- Premium Surcharge Help Sheet: 2021
- Spousal Plan Calculator: 2021 (print version)
- Life Insurance: 2021
- Leave Without Pay: 2021
- Active Employees: 2021(state agency and higher education institution employees)
- Retiree: 2021 (Medicare and Non-Medicare)
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 - When may a subscriber change health plans?
- 182-08-200 - Employer contribution when changing agency employment
- 182-12-109 - Definitions
- 182-12-113 - Obligations of state agency in employee eligibility
- 182-12-129 - What happens when an employee changes positions due to layoff?
- 182-12-131 - How eligible employees maintain the employer contribution toward insurance coverage
- 182-12-133 - Options for continuing coverage eligible when on certain types of leave or Layoff?
- 182-12-141 - Revert from an eligible position to an another position
- 182-12-171 - Retiree eligibility