Due to COVID-19, HCA’s lobby is closed. Learn more about your customer service options.

Reinstating medical coverage after waiving

General information and requirements

Updated 2/27/2020

Applicable to

  • Employees covered by Public Employees Benefits Board (PEBB) benefits who are requesting to reinstate medical coverage after waiving.

Relevant rule

  • Once medical coverage is waived, enrollment is only allowed during annual open enrollment or a special open enrollment (WAC 182-12-128).

Additional information

  • During annual open enrollment, employees may reinstate medical if they submit an Employee Enrollment/Change form to their employing agency before the end of the annual open enrollment (usually November 30). Coverage will become effective January 1 of the following year.
    • During annual open enrollment, employees may also reinstate PEBB medical through PEBB My Account.
  • During a special open enrollment, employees may return from waived status if they submit an Employee Enrollment/Change form to their employing agency no later than 60 days after the event that creates the special open enrollment.
    • For specific information, refer to the list of Special Open Enrollment Circumstances (Policy 45-2, Addendum 45-2A).
    • Employees returning from waived status due to loss of other employer-based group medical must submit an Employee Enrollment/Change form and provide proof of loss of other coverage (also known as proof of the qualifying event) to their employing agency no later than 60 days after loss of other medical coverage. The employing agency will forward the Employee Enrollment/Change form and proof of loss to Health Care Authority for processing.
    • "Proof of loss" is a statement from the insurance company or letter from the previous employer stating the date medical coverage was lost and the names of the members who were covered. Proof of loss must be provided to enroll outside of the annual open enrollment period.

Employee requirements

Employees may reinstate PEBB Medical... ...no later than... ...or this will happen
During annual open enrollment. The last day of the annual open enrollment period.

Employees may reinstate medical if they submit an Employee Enrollment/Change form to their employing agency. (This may also be done through My Account).

Medical will be reinstated January 1 of the following year.

The employee must wait for the next annual open enrollment to reinstate medical coverage or have a qualifying event that triggers a special open enrollment.
During a special open enrollment.

60 days after the qualifying event that triggered the special open enrollment. The change must correspond to the event that triggered the special open enrollment.

To reinstate medical during a special open enrollment, the employee must submit an Employee Enrollment/ Change form and proof of loss (if the reinstatement is due to loss of other coverage) to their employing agency.

The effective date will be the first day of the month after the later of the date of the event or date the form is received.

Exception: If the special enrollment is due to a birth, adoption, or assuming a legal obligation for total or partial support in anticipation of adoption, the effective date for coverage will begin the first of the month in which the event occurred.

The employee must wait for the next annual open enrollment to reinstate medical coverage or have a qualifying event that triggers a special open enrollment.

Employer requirements

Employer... ...no later than... ...or this will happen
During annual open enrollment

Verify the  Employee Enrollment/Change form has been completed correctly and received

The end of the annual open enrollment period. If the form is not returned within the annual open enrollment period, notify the employee that the request to reinstate coverage cannot be reinstated until the next annual open enrollment or until a qualifying event triggers a special open enrollment.
Enter employee coverage elections in the PAY1 insurance system. Immediately upon receipt of the Employee Enrollment/Change form. A delay in benefits to be enrolled in the PAY1 insurance system may result in claims processing challenges and the agency's financial responsibility.
During a special open enrollment

Verify that the submitted Employee Enrollment/Change form is completed correctly and received

60 days after the event that created the special open enrollment. The change must correspond to the event that created the special open enrollment. Proof of the event that created the special open enrollment is required. If the form is not returned within 60 days, notify the employee that the request to reinstate coverage was more than 60 days after the event that created the special open enrollment. The employee must wait for the next annual open enrollment to reinstate medical coverage or have a new qualifying event that triggers a special open enrollment.
If the reinstatement is due to loss of other coverage, send the form through FUZE to the HCA to enter employee coverage elections in the insurance system.

Immediately upon receipt of the Employee Enrollment/Change form and proof of loss.

HCA will send FUZE confirmation of the action taken upon completion.

The effective date for insurance coverage will be the first day of the month after the later of the date of the event or date the form was received.

A delay in benefits to be enrolled in the PAY1 insurance system may result in claims processing challenges and an agency's financial responsibility (WAC 182-08-180).

Guidance resources

Forms

  • Employee Enrollment/Change form 2021
  • Medical Only Employee Enrollment/Change form 2021
  • Premium Surcharge Change form (for current employees) 2021
  • Premium Surcharge Help Sheet 2021
  • Spousal Plan Calculator (print version) 2021
  • Declaration of Tax Status 2021
  • Extended Dependent Certification 2021
  • Certification of Dependent with a Disability 2021

System keying in PAY1

WAC references and their general subject matter