Deferring coverage

Your deferral rights

If you choose not to enroll at retirement or separation from state service, and you want to maintain your ability to enroll in PEBB benefits in the future, you must:

  • Defer (postpone or interrupt) your enrollment in PEBB retiree medical and dental coverage at or after retirement.
    AND
  • Be continuously enrolled in other medical coverage, as described in the eligibility section below.

If you defer enrollment in a PEBB retiree health plan, you may not enroll in a PEBB dental plan during your deferral period.

Except as stated in the  eligibility section below, if you defer enrollment in a PEBB retiree health plan, you also defer enrollment for your dependents.

Eligibility

You may defer enrollment in PEBB retiree benefits if:

  • You are continuously enrolled in a PEBB, or Washington State school district, or educational service district-sponsored medical plan as a dependent, including such coverage under COBRA or continuation coverage.
  • Beginning January 1, 2001, if you are continuously enrolled in employer-based group medical insurance as an employee or the dependent of an employee, or such medical insurance continued under COBRA coverage or continuation coverage. This does not include an employer’s retiree coverage.
  • Beginning January 1, 2001, if you are continuously enrolled in medical coverage as a retiree or a dependent of a retiree in TRICARE or the Federal Employees Health Benefits Program. You will have a one-time opportunity to enroll or reenroll in a PEBB health plan.
  • Beginning January 1, 2006, if you are continuously enrolled in Medicare Part A and Part B and a Medicaid program that provides creditable coverage. To be considered creditable coverage, your Medicaid coverage must include coverage for medical and hospital benefits. Your eligible dependents who are not eligible for creditable coverage under Medicaid may continue PEBB health plan enrollment.
  • Beginning January 1, 2014, if you are not eligible for Medicare Part A and Part B you may defer PEBB retiree coverage if enrolled in qualified health plan coverage through a health benefit exchange established under the Affordable Care Act. This does not include Medicaid coverage, also known as Apple Health in Washington State. You will have a one-time opportunity to enroll or reenroll in a PEBB health plan. If you live in Washington State, you can find information about qualified health plans through the Washington State Health Benefit Exchange.The PEBB Program still must receive your Retiree Coverage Election/Change form (Form A) within 60 days of your active employee coverage ending in order to defer your state retiree coverage.

How to defer coverage

To defer enrollment in a PEBB health plan, retiring employees or enrolled retiree subscribers must submit a Retiree Coverage Election/Change form (Form A) to the PEBB Program requesting to defer.

  • If you are a retiring or separating employee, the PEBB Program must receive the form no later than 60 days after your employer-paid coverage, COBRA coverage, or continuation coverage ends. The PEBB Program will defer your enrollment the first of the month following the date your employer-paid or COBRA coverage ends.
  • If you are a retiree enrolled in PEBB retiree insurance coverage, the PEBB Program must receive your election/change form before you defer coverage. Enrollment will be deferred effective the first of the month following the date the PEBB Program receives your form. If the form is received on the first day of the month, coverage will end on the last day of the previous month.

If you defer enrollment in PEBB retiree coverage while enrolled in other coverage and lose such coverage, you must enroll in a PEBB retiree health plan or defer enrollment. If you don’t, you will lose eligibility to enroll in PEBB retiree insurance coverage as described in WAC 182-12-205 or 182-12-200.

If you met eligibility requirements and your employer-paid coverage, COBRA coverage, or continuation coverage ended between January 1, 2001 and December 31, 2001, you were not required to submit a deferral form at that time. However, you must have met all other requirements to have deferred your PEBB retiree medical/dental coverage.

Deferral rights for survivors of employees or retirees

A surviving spouse, state-registered domestic partner, or child of an employee, retiree, or Washington State school district or educational service district employee who is eligible for PEBB retiree coverage under WAC 182-12-265 may defer enrollment under one of the circumstances listed below:

  • If a survivor is continuously enrolled in a PEBB, Washington State school district, or educational service district-sponsored medical plan as a dependent, including such coverage under COBRA or continuation coverage.
  • Beginning January 1, 2001, if a survivor is continuously enrolled in employer-based group medical insurance as an employee or the dependent of an employee, or such medical insurance continued under COBRA coverage or continuation coverage.
  • Beginning January 1, 2001, if a survivor is continuously enrolled in medical coverage as a retiree or the dependent of a retiree in TRICARE or the Federal Employees Health Benefits Program. These survivors will have a one-time opportunity to enroll or reenroll in a PEBB health plan.
  • Beginning January 1, 2006, if a survivor is continuously enrolled in Medicare Part A and Part B and a Medicaid program that provides creditable coverage. To be considered creditable coverage, the survivor’s Medicaid coverage must include coverage for medical and hospital benefits. A survivor’s eligible dependent(s) who are not eligible for creditable coverage under Medicaid may continue PEBB health plan enrollment.
  • Survivors not eligible for Medicare Part A and Part B may defer PEBB retiree insurance coverage if enrolled in qualified health plan coverage offered through a health benefits exchange established under the Affordable Care Act. This does not include Medicaid coverage, also known as Apple Health in Washington State. These survivors will have a one-time opportunity to enroll or reenroll in a PEBB health plan.

If a survivor defers enrollment in PEBB retiree insurance coverage, he or she may not enroll in a PEBB dental plan.

How to defer coverage

To defer enrollment in PEBB retiree insurance coverage, a survivor must submit a Retiree Coverage Election/Change form (Form A) to the PEBB Program:

  • In the event of an employee or retiree’s death, the PEBB Program must receive the form no later than 60 days after the death. Enrollment will be deferred effective the first of the month following the date of the death.
  • If a survivor enrolls in PEBB retiree insurance coverage and is eligible to defer coverage in the future, the PEBB Program must receive the form before the survivor defers coverage. Enrollment will be deferred effective the first of the month following the date the PEBB Program receives the form. For example, if the form is received on the first day of the month, coverage will end on the last day of the previous month.

Deferral rights for survivors of emergency services personnel

A surviving spouse, state-registered domestic partner, or dependent child of emergency services personnel killed in the line of duty who is eligible for PEBB retiree insurance coverage under WAC 182-12-250 may defer enrollment under one of the circumstances listed below:

  • If a survivor is continuously enrolled in the PEBB, Washington State school district, or educational service district-sponsored medical plan as a dependent.
  • Beginning January 1, 2001, if a survivor is continuously enrolled in employer-based group medical insurance as an employee or the dependent of an employee, COBRA coverage or continuation coverage.
  • Beginning January 1, 2001, if a survivor is continuously enrolled in medical coverage as a retiree or the dependent of a retiree in TRICARE or the Federal Employees Health Benefits Program. These survivors will have a one-time opportunity to enroll or reenroll in a PEBB health plan.
  • Beginning January 1, 2006, if a surviving dependent is continuously enrolled in Medicare Part A and Part B and a Medicaid program that provides creditable coverage. To be considered creditable coverage, the surviving dependent’s Medicaid coverage must include coverage for medical and hospital benefits. A survivor’s eligible dependent(s) who are not eligible for creditable coverage under Medicaid may continue PEBB health plan enrollment.
  • Survivors who are not eligible for Medicare Part A and Part B may defer PEBB retiree insurance coverage if enrolled in qualified health plan coverage offered through a health benefit exchange established under the Affordable Care Act. This does not include Medicaid coverage, also known as Apple Health in Washington State. These survivors will have a one-time opportunity to enroll or reenroll in a PEBB health plan.

If a survivor defers enrollment in PEBB retiree insurance coverage, he or she may not enroll in a PEBB dental plan.

How to defer coverage

To defer enrollment in PEBB retiree insurance, a survivor must submit a Retiree Coverage Election/Change form (Form A) to the PEBB Program. The form must be received by the PEBB Program no later than 180 days after the later of:

  • The death of the emergency service worker.
  • The date on the eligibility letter from the Washington State Department of Retirement Systems or the board for volunteer firefighters and reserve officers.
  • The last day the survivor was covered under any health plan through the emergency service worker’s employer.
  • The last day the survivor was covered under COBRA coverage from the emergency service worker’s employer.

How to enroll after deferring PEBB coverage

If a retiree or survivor deferred enrollment in PEBB retiree insurance coverage, he or she may enroll under the following circumstances, as long as he or she has had continuous enrollment in qualifying coverage as required.

  • During any PEBB annual open enrollment. The PEBB Program must receive the Retiree Coverage Election/Change form (Form A) and proof of continuous enrollment in other qualified health plan coverage no later than the last day of the PEBB Program’s open enrollment period. You cannot enroll during open enrollment if there has been a gap in coverage. To return from deferral during open enrollment, your other coverage must be continuous through December 31.
  • When other qualified coverage ends. The PEBB Program must receive the Retiree Coverage Election/Change form (Form A) no later than 60 days after the date other qualifying coverage ends. Enrollment will begin the first day of the month after other qualifying coverage ends. Although a retiree or survivor has 60 days to enroll, he or she must pay PEBB premiums and any applicable surcharges back to when other qualifying coverage ended. Proof of continuous enrollment in other qualifying medical coverage must list when the coverage began and ended.

A retiree or survivor has a one-time opportunity to enroll in PEBB medical and dental coverage if he or she deferred enrollment in PEBB coverage for TRICARE, the Federal Employees Health Benefits Program, or coverage through a health benefit exchange established under the Affordable Care Act.

How to enroll after deferring PEBB coverage for Medicaid

Retirees or survivors who defer PEBB retiree insurance coverage while continually enrolled in Medicare Part A and Part B and a Medicaid program that provides creditable coverage may enroll in PEBB coverage during any PEBB Program annual open enrollment or if they lose their Medicaid coverage. The PEBB Program must receive the Retiree Coverage Election/Change form (Form A) no later than 60 days after the date Medicaid coverage ends, or no later than the end of the calendar year when the retiree or survivor’s Medicaid coverage ends, if he or she was also eligible under subsidized Medicare Part D.

Retirees or survivors who defer enrollment may enroll in a PEBB health plan if he or she receives formal notice that the Health Care Authority has determined it is more cost-effective to enroll the retiree or survivor (or his or her eligible dependent) in PEBB medical than a medical assistance program.

How to cancel coverage

To cancel your PEBB retiree insurance coverage, you must submit your request in writing to:

Health Care Authority
PEBB Program
P.O. Box 42684
Olympia, WA 98504-2684

Your insurance coverage will end on the last day of the month in which the PEBB Program receives your written notice. If your written notice is received on the first day of the month, coverage will end on the last day of the previous month.

If you are enrolled in a Medicare Advantage plan, you must also send the PEBB Program a completed Medicare Advantage Plan Disenrollment form (Form D). We will send the form to your plan, which will remove you from coverage on the first of the month after the plan receives the form.

If you cancel your PEBB retiree insurance coverage, you cannot enroll again later unless you regain eligibility for PEBB coverage, for example, by returning to employment in a PEBB Program, Washington State school district, or educational service district benefits-eligible position.

Ending PEBB coverage

PEBB insurance covers an entire month and must end as follows:

  • When you or a dependent loses eligibility for PEBB benefits, coverage ends on the last day of the month in which eligibility ends.
  • Coverage for you and your enrolled dependents ends on the last day of the month that you last paid the full premium. The PEBB Program charges a full month’s premium for each calendar month of coverage. The HCA will not prorate a premium if an enrollee dies or cancels his or her coverage before the end of the month.

To find out your options when coverage ends see eligibility and enrollment information for COBRA and continuation coverage (formerly leave without pay) subscribers.