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Newly Eligible Employees

Updated:3/24/2017

Applicable to

All employees when determining eligibility for Public Employee Benefits (PEB) insurance.

Eligibility for PEBB benefits

Employees establish eligibility based on categories described in WAC 182-12-114. Eligibility is determined solely by the criteria of the category that most closely describes their work.

Employee categories

  • Hourly/salaried employees
  • Seasonal employees - an employee hired to work during a recurring, annual season with a duration of three months or more, and anticipated to return each season to perform similar work. A season is any recurring, cyclical period of work at a specific time of year that lasts three to eleven months.
  • Higher-education faculty – academic year and quarter/semester-to-quarter/semester
  • Elected and full-time appointed officials
  • Justices and judges

Determining eligibility

PEBB provides worksheets as the method for determining eligibility. These worksheets are described in the Guide to Eligibility Worksheets.

The worksheets are made up of five workplace scenarios, or series:

  • “A” Series (1-5): For new hires
  • “B” Series (1-7): For existing employees who have a change in employment status
  • “C” Series (1-11): For benefits-eligible employees who are leaving work
  • “D” Series (1-6): For employees who are returning to work
  • “E” Series (1-2): For eligible dependents

Hours that are excluded in determining eligibility include:

  • Standby hours.
  • Any temporary increases caused by training or emergencies in work hours, of six months or less, that have not been nor anticipated to be part of the regular work schedule or pattern. Agencies must request PEBB approval prior to including these hours to determine eligibility.

The worksheets provide for:

  • Decisions which are compliant with RCW and WAC.
  • Required notice and information to employees.
  • Receipt of the required notice and information.
  • Guidance and suggestions for the employer and the employee.

Using the worksheets

  • Select the appropriate worksheet for your employee.
  • Always “open” a new worksheet for each new employee.
  • Complete and save the worksheet either electronically or as a hard copy.
  • Provide a copy for the employee.
  • Have the employee sign the worksheet. If they are not available to provide a signature, PEBB will accept the following:
    • Email
    • Email read receipt
    • Any other written response from the employee acknowledging receipt of the worksheet
    • A copy of the tracking information, if sent through the mail
    • Electronic signatures
    • Make a note on the worksheet if the employee is unwilling or unavailable to sign it

Affordable Care Act (ACA) codes (state agency and higher education institutions only)

The worksheets also include a section for eligibility under the ACA. The ACA requires employers to assign the correct status code for each employee, returning employee, and an employee with a change in employment status.

Note: The ACA definition of full-time does not determine eligibility for PEBB benefits.

Based on the method of notification chosen by your agency, record the ACA code in your system of record (HRMS, PPS, etc.) or in Pay1.

PEBB stipulates the use of the worksheets as follows

  • State agencies and higher education institutions must use the worksheets provided by the PEBB program to determine eligibility and enrollment in benefits, unless otherwise approved in writing. WAC 182-12-113: If an alternate method is approved, a copy of the updated alternate method must be provided to PEBB in December for review and approval.
  • Employer groups and K-12 school districts are not required to, but are encouraged to use the worksheets to ensure accurate determination of employee eligibility based on WAC 182-12-114.

WAC references

182-12-109 - Definitions

182-12-113 - What are the obligations of a state agency in the application of employee eligibility?

182-12-114 - How do employees establish eligibility for public employees benefits board (PEBB) benefits?