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PEBB Administrative Policies and Procedures

The PEBB Program follows the rules in Washington Administrative Code (WAC).

The PEBB Program's administrative policies describe how we implement a law or rule affecting participation in PEBB benefits. The statements made in these documents reflect our interpretations of the eligibility and enrollment rules.

Employee eligibility and enrollment 

  • Policy 11-1: Providing notifications to employees and employers (Effective 1/1/2020)
  • Policy 11-3: Correcting employing agency enrollment errors (Effective 1/1/2020)
  • Policy 15-1: Determining eligibility for seasonal employees and maintenance of employer contribution through off-season (Effective 1/1/2020)
  • Policy 17-1: Determining faculty eligibility for summer/short class sessions (Effective 1/1/2020)
  • Policy 17-2: Determining faculty eligibility after a layoff (Effective 1/1/2019)
  • Policy 17-3: Determining faculty eligibility for off-quarter/semester and for decreases in workload (Effective 1/1/2019)
  • Policy 19-1: Termination due to Loss of Eligibility (Effective 1/1/2020)

Retiree eligibility and enrollment

  • Policy 21-1: Retiree deferral form exemption (Effective 1/1/2020)
  • Policy 26-1: Administering PEBB insurance in coordination with Medicare Part D (Effective 4/1/2020)

Dependent Eligibility and Enrollment

  • Policy 31-1: Verifying dependent eligibility (Effective 1/1/2020)
  • Policy 31-2: Use of spousal plan questionnaire and calculator tools (Effective 1/1/2020)
  • Policy 33-1: Verifying legal union's residency status (Effective 1/1/2020)
  • Policy 36-1: Certifying eligibility for dependent children with disabilities who are age 26 or older (Effective 1/1/2020)
  • Policy 37-1: Certifying eligibility for extended dependents (Effective 1/1/2020)

Open Enrollment 

Appeals

  • Policy 60-1: Required appeals related documents when the PEBB program is hearing an appeal (Effective 1/1/2020)

Administrative - Permanent

  • Policy 90-1: Allowable mid-year employer group terminations (Effective 1/1/2020)
  • Policy 90-2: What authority do employer groups or charter schools need before contracting with the Health Care Authority (HCA) for participation in PEBB for insurance coverage? (Effective 1/1-2020)
  • Policy 90-3: Determining if an employer group or charter school requesting eligibility standards different from Public Employee Benefits Board (PEBB) program rules shall be approved (Effective 1/1/2020)
  • Policy 91-1: Requesting reasonable alternative for completing wellness incentive program requirements or avoiding Tobacco Use Premium Surcharge (Effective 1/1/2020)
  • Policy 91-2: Tobacco as it relates to religious or ceremonial use (Effective: 1/1/2020)
  • Policy 91-3: Washington Wellness Worksite Designation Program Incentive Requirements (Effective 1/1/2020)
  • Policy 93-2: PEBB Program payment plans (Effective: 1/1/2020)
  • Policy 94-1: Accessing PEBB Program salary reduction plan document (Effective date: 1/1/2020)
  • Policy 94-2: Accessing PEBB Program wellness plan document (Effective date: 1/1/2020)

Proposed and rescinded or superseded policies