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When employees may make changes

Updated: 2/27/2020

Applicable to

All employees eligible for Public Employee Benefits (PEB) insurance who wish to make changes to their enrollment or health plan elections outside of their initial 31 day enrollment period.

Making changes in coverage

To make changes, the required forms must be received by the employee’s personnel, payroll, or benefits office within the PEBB Program’s timelines associated with the annual open enrollment or when a special open enrollment event occurs.

Annual open enrollment

From November 1-30 each year, employees can make changes to their PEBB account that will take effect January 1 of the following year. The employee must submit the appropriate Employee Enrollment/Change form between November 1 and 30. They may also make some changes online using My Account.

During annual open enrollment employees may:

  • Change medical or dental plans.
  • Reinstate coverage without proof of loss (if they previously waived medical coverage).
  • Waive medical coverage (if they have other employer-based group medical insurance, TRICARE, or Medicare).
  • Add eligible dependents without proof of loss (dependent verification documents are required for dependents not previously verified).
  • Remove dependents.
  • Change premium payment plan (IRC Section 125) waiver status.
  • Change the IRC tax status of a dependent Declaration of Tax Status form.
  • Enroll or reenroll in a Medical Flexible Spending Arrangement (FSA) or Dependent Care Assistance Program (DCAP) (for state agency and higher education institution employees only).
  • Attest or reattest to the spousal or state-registered domestic partner premium surcharge*, if applicable.

Note: Employees may reattest to the tobacco use premium surcharge at any time.

Employees may make the following changes online using My Account

  • Change medical and/or dental plan(s)
  • Waive medical coverage
  • Enroll or remove dependents from coverage
  • Reattest to the spousal or state-registered domestic partner premium surcharge, if applicable.

Go to My Account.

Note: Employees may reattest to the tobacco premium surcharge at any time.

After completing their changes online employees should:

  • Print or save their confirmation page.
  • Check back in two business days to verify coverage is correct.

Life insurance and long term disability (LTD) insurance

  • There is no annual open enrollment for life and long term disability (LTD) insurance.
  • Changes can be made at any time, although some changes require carrier approval.

Special open enrollment

Certain events allow employees to make account changes outside of annual open enrollment. These are called Special Open Enrollment (SOE) events. Changes must be allowable, correspond to, and be consistent with the event that creates the SOE.

Employees must provide proof of the event that created the special open enrollment (for example, a marriage or birth certificate).

Refer to Addendum 45-2A SOE matrix whenever an employee is requesting to make changes outside of annual open enrollment. The matrix provides a summary of permitted election changes, including:

  • Valid documents used to verify proof of the SOE event
  • What changes are allowed, or not allowed, per the SOE
  • Timelines

To make a change, the employee must complete and submit the appropriate form(s) and proof of the qualifying event. The employing agency must receive the forms and proof of the event no later than 60 days* after the date of the event. Changes are effective the first of the month following the receipt of the form.

*When adding a newborn or newly adopted child that increases an employee’s premium, you must receive the required forms no later than 12 months after the date of the birth, adoption, or when assuming legal obligation. If adding the newborn or newly adopted child does not change the employee’s premium, the employee may submit the required forms and proof of the event as soon as possible.

Forms

Resources

WAC references

  • WAC 182-08-198 - When may a subscriber change health plans?
  • WAC 182-08-199 - When may an employee enroll in or change their election under the premium payment plan, Flexible spending arrangement (FSA), or dependent care assistance program (DCAP)?
  • WAC 182-12-128 - Waiving enrollment and reenrolling in PEBB medical
  • WAC 182-12-262 - When may subscribers enroll or remove eligible dependents?