Change your coverage
Learn the requirements to make changes to your PEBB coverage.
On this page
Before you make a change, it is important to:
- Make sure the health plan is available in your area.
- Check the plan’s provider directory or contact your plan to make sure your provider is in the plan’s network.
- Compare monthly plan costs (premiums).
- Compare benefits and your costs for care (deductibles, coinsurance, and/or copays).
You must submit the appropriate form(s) to your personnel, payroll, or benefits office during the PEBB Program's annual open enrollment or when a special open enrollment event occurs, within the PEBB Program’s timelines.
To make a change during the PEBB Program’s annual open enrollment:
Your personnel, payroll, or benefits office must receive the appropriate Employee Enrollment/Change form between November 1-30. You may also make some changes using My Account.
To make a change when a special open enrollment event occurs:
Your personnel, payroll, or benefits office must receive the appropriate Employee Enrollment/Change form no later than 60 days after the event that created the special open enrollment. However, if adding a newborn or newly adopted child, and adding the child increases your premium, your employer must receive this form no later than 12 months after the birth or adoption.
You can make some changes during the year without a special open enrollment event.
- Change your name and/or address. Use the Employee Enrollment/Change form.
- Remove dependent(s) from coverage due to loss of eligibility (required). Your personnel, payroll, or benefits office must receive a complete Employee Enrollment/Change form no later than 60 days after the event.
- Change your life insurance beneficiary information. See the Life insurance page for details.
- Apply for, cancel, or change coverage amounts for supplemental life and accidental death and dismemberment (AD&D) insurance. See the Life insurance page for details.
- Apply for, cancel, or change auto or home insurance coverage. See the Auto & home insurance page for details.
- Enroll in, cancel, or decrease or increase the waiting period for optional long-term disability coverage. Use the Long-Term Disability Enrollment/Change form. If you request to decrease the waiting period or enroll in optional LTD coverage later than 31 days after becoming eligible for PEBB benefits, you must also complete the Long-Term Disability Evidence of Insurability form. See the Long-term disability insurance page for details.
- Start, stop, or change your contribution to your health savings account (HSA). Use the Employee Authorization for Payroll Deduction to Health Savings Account form.
- Change your HSA beneficiary information. Use the Health Savings Account Beneficiary Designation form.
- You can only change medical or dental plans during the PEBB Program's annual open enrollment (November 1–30) or if you have a special open enrollment event.
- All eligible family members must enroll in the same health plan. (Family members can have different providers.)
- If you have a provider you want to stay with, contact your plan or check the plan’s provider directory to make sure your provider is in the plan’s network.
- You cannot be enrolled on two PEBB accounts at the same time. If you and your spouse or registered domestic partner are both eligible subscribers, you need to choose which of you will cover yourselves and your eligible children (including adult children who are also eligible for PEBB coverage as an employee). Enrolled family members will be listed on one account, not both.
Certain events let you make account changes (like changing a health plan or enrolling a dependent) outside of annual open enrollment. We call these special open enrollment events.
You must provide proof of the event that created the special open enrollment (for example, a marriage or birth certificate).
These changes may be allowed as a special open enrollment:
|If this event happens...||Add dependent||Remove dependent||Change PEBB medical and/or dental plan||Waive PEBB medical coverage||Enroll after waiving PEBB medical coverage|
|Marriage, registering a domestic partner, as defined by Washington Administrative Code 182-12-260(2), birth, adoption, or assuming a legal obligation for total or partial support in anticipation of adoption.||Yes1||Yes2||Yes||Yes||Yes|
|Child becomes eligible as an extended dependent through legal custody or legal guardianship.||Yes||No||Yes||No||Yes|
|Child becomes eligible as a dependent with a disability.||Yes||No||Yes||No||Yes|
|Employee or dependent loses eligibility for other coverage under a group health plan or through health insurance, as defined by the Health Insurance Portability and Accountability Act (HIPAA).||Yes||No||Yes||No||Yes|
|Employee has a change in employment status that affects the employee's eligibility for his or her employer contribution toward his or her employer-based group health plan.||Yes||Yes||Yes||Yes||Yes|
|Employee's dependent has a change in his or her own employment status that affects his or her eligibility for the employer contribution under his or her employer-based group health plan.||Yes||Yes||Yes||Yes||Yes|
|Employee or dependent has a change in enrollment under another employer-based group health plan during its annual open enrollment that does not align with the PEBB Program’s annual open enrollment.||Yes||Yes||No||Yes||Yes|
|Employee's dependent moves from outside the United States to live within the United States, or from within the United States to live outside of the United States.||Yes||Yes||No||Yes||Yes|
|Employee or dependent has a change in residence that affects health plan availability.||No||No||Yes||No||No|
|A court order or National Medical Support Notice requires the employee or any other individual to provide a health plan for an eligible child of the employee.||Yes||Yes||Yes||No||Yes|
|Employee or dependent becomes entitled to or loses eligibility for Medicaid or a state Children’s Health Insurance Program (CHIP).||Yes||Yes||Yes||Yes||Yes|
|Employee or a dependent becomes eligible for a state premium assistance subsidy for PEBB health plan from Medicaid or a state CHIP.||Yes||No||Yes||No||Yes|
|Employee or dependent becomes entitled to Medicare or loses eligibility under Medicare, or enrolls in or terminates enrollment in a Medicare Part D plan.||No||No||Yes||Yes||No|
|Employee's or dependent’s current health plan becomes unavailable because the employee or dependent is no longer eligible for a health savings account (HSA).||No||No||Yes||No||No|
|Employee or dependent experiences a disruption of care that could function as a reduction in benefits for the employee or his or her dependent for a specific condition or ongoing course of treatment (requires approval by the PEBB Program).||No||No||Yes||No||No|
|Employee or dependent becomes eligible and enrolls in TRICARE, or loses eligibility for TRICARE.||No||No||No||Yes||Yes|
|Employee becomes eligible and enrolls in Medicare, or loses eligibility for Medicare.||No||No||No||Yes||Yes|
1Subscriber may add only the new spouse, registered domestic partner, or child(ren) of the spouse or partner. Existing dependents may not be added.
2Subscriber may only remove a dependent from PEBB coverage if the dependent enrolls in the new spouse’s or registered domestic partner’s plan.
For more details, see PEBB Program Policy 45-2A and refer to Washington Administrative Code (WAC):
- When may a subscriber change health plans?
- When may an employee enroll in or change his or her election under the premium payment plan, Medical Flexible Spending Arrangement (FSA) or Dependent Care Assistance Program (DCAP)?
- When may an employee waive enrollment in PEBB medical, and when may they enroll in PEBB medical after waiving enrollment?
- When may subscribers enroll or remove eligible dependents?
From November 1–30 each year, you can make changes to your PEBB account that will take effect January 1 of the following year.
During open enrollment you can:
- Change medical or dental plans.
- Enroll or remove eligible dependents.
- Enroll in a medical plan, if you previously waived PEBB medical for other employer-based group medical insurance coverage, TRICARE, or Medicare.
- Waive enrollment in PEBB medical if you have or are enrolling in other employer-based group medical insurance, TRICARE, or Medicare effective January 1. (Coverage through the Health Benefit Exchange is not group coverage.)
- Enroll or re-enroll in a Medical Flexible Spending Arrangement (PEBB benefits-eligible state agency and higher-education employees only).
- Enroll or re-enroll in the Dependent Care Assistance Program (PEBB benefits-eligible state agency and higher-education employees only).
- Change your election under the state’s premium payment plan.
During open enrollment you can make changes online using My Account. You can:
- Change your medical and/or dental plan(s).
- Waive medical coverage if you are enrolled in other employer-based group medical insurance coverage, TRICARE, or Medicare (coverage through the Health Benefit Exchange is not group coverage).
- Remove family members from your coverage.
Please print or save your confirmation page when you’ve completed your changes. Check back in two business days to verify the coverage you selected and your spousal or state-registered domestic partner coverage attestation is correct.
When you submit an online plan change, please wait two business days to make any additional online plan changes.