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Waiving employee medical coverage

General information and requirements

Updated 2/27/2020

Applicable to

  • Employees covered by Public Employees Benefits Board (PEBB) benefits who are requesting to waive PEBB medical.

Relevant rule

(WAC 182-12-128)

  • An employee may waive enrollment in PEBB medical if he or she is enrolled in other employer-based group medical, Tricare or Medicare.
  • An employee who waives enrollment in PEBB medical must enroll in dental, basic life and basic long-term disability insurance (unless the employing agency does not participate in these PEBB insurance coverages).
  • If an employee waives medical coverage, their dependents cannot enroll in a medical plan.

Employee options

Employees may waive PEBB Medica​l ... ...no later than... ...or this will happen
When the employee becomes eligible.

31 days after the date the employee becomes eligible (this is generally the first day of work).

The employee must submit the completed Employee Enrollment/Change form to their employing agency.

PEBB medical is waived the first day of the month following the date the employee becomes eligible. If the employee becomes eligible on the first working day of the month, coverage is waived that day. 

Newly eligible employees who do not return an enrollment form to their employing agency within 31 days will be enrolled in Uniform Medical Plan Classic as a single subscriber.
During annual open enrollment. The last day of the annual open enrollment period.

The employee must submit the completed Employee Enrollment/Change form to their employing agency before the end of the annual open enrollment. (This may also be done through My Account on the PEBB website).

Medical will be waived effective January 1 of the following year.

The employee must wait for the next annual open enrollment to waive 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. Refer to Policy 45-2, Addendum 45-2A)

The employee must submit the completed Employee Enrollment/Change form to their employing agency no later than 60 days after the event that creates the special open enrollment. The employee must also provide evidence of the event that triggered the special open enrollment.

The effective date is the last day of the month after the later of (a) the date of the event, or (b) the date the form is received. If the later of (a) or (b) is the first of the month, the waive date is the last day of the previous month. 

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

Employer requirements

Employer...​ ...no later than... ...or this will happen
When the employee becomes eligible

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

31 days after the date the employee becomes eligible. If the form is not returned within 31 days, notify the employee they have been enrolled in the "default plan" Uniform Medical Plan Classic and must now wait for the next annual open enrollment or have a qualifying event that triggers a special open enrollment to change.
Enter employee coverage elections in PAY1. Immediately upon receipt of the Employee Enrollment/Change form. Late updates to PAY1 may result in error correction and account discrepancies that may be subject to premium payment and refund rules where no more than three months of accounting adjustments to the agency or individual can be made (WAC 182-08-187).
During annual open enrollment

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

The end of the open enrollment period. If the form is not returned within the annual open enrollment period, notify the employee the request to waive medical coverage was outside the annual open enrollment and they cannot waive medical coverage until the next annual open enrollment or they have a qualifying event that triggers a special open enrollment.
Enter employee coverage elections in PAY1. Immediately upon receipt of the Employee Enrollment/Change form. Late updates to PAY1 may result in error correction and account discrepancies that may be subject to premium payment and refund rules where no more than three months of accounting adjustments to the agency or individual can be made (WAC 182-08-187).
During special open enrollment

Verify the submitted Employee Enrollment/Change form has been completed correctly and the evidence of the event is valid for the event that created the open enrollment.

60 days after the event that created the special open enrollment. The change must correspond to the event that created the special open enrollment. If the form and evidence of the event is not returned within 60 days, notify the employee their request to waive medical coverage due to a special open enrollment was beyond 60 days after the event that created the special open enrollment. The employee must wait for the next annual open enrollment to waive medical coverage or have a new qualifying event that triggers a special open enrollment.
Enter employee coverage elections in PAY1. Immediately upon receipt of the Employee Enrollment/Change form. Late updates to PAY1 may result in error correction and account discrepancies that may be subject to premium payment and refund rules where no more than three months of accounting adjustments to the agency or individual can be made (WAC 182-08-187).

Guidance resources

Forms

  • Employee Enrollment/Change form (2021)

  • Medical Only Employee Enrollment/Change form (2021)

System keying in PAY1

Common questions and issues

PEBB Knowledge Base

Perspay Knowledge Base

WAC references

  • 182-08-015 Definitions
  • 182-08-180 Premium payments and refunds.
  • 182-08-187 How do employing agencies correct enrollment errors and is there a limit to retroactive enrollment?
  • 182-08-190 The employer contribution is set by HCA and paid to HCA for all eligible employees.
  • 182-08-197 When must newly eligible employees select PEBB benefits and complete enrollment forms?
  • 182-12-109 Definitions
  • 182-12-128 May an employee waive health plan enrollment?