WAC 182-08-199
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)? An eligible employee (as described
in WAC 182-12-116) may enroll in or change his or her election
under the premium payment plan, medical flexible spending
arrangement (FSA), or dependent care assistance program (DCAP)
at the following times:
(1) When they are newly eligible under WAC 182-12-114, as
described in WAC 182-08-197.
(2) During annual open enrollment: An eligible employee
(as described in WAC 182-12-116) may enroll in or change their
election under the state's premium payment plan, medical FSA
or DCAP during the annual open enrollment. Employees must
submit, in paper or on-line, the appropriate enrollment form
to enroll or reenroll no later than the last day of the annual
open enrollment. The enrollment or new election will be
effective January 1st of the following year.
(3) During a special open enrollment: Employees may
enroll or change their election under the state's premium
payment plan, medical FSA or DCAP outside of the annual open
enrollment if a special open enrollment event occurs. The
enrollment or change in enrollment must be allowable under
Internal Revenue Code (IRC) and correspond to and be
consistent with the event that creates the special open
enrollment. To make a change or enroll, the employee must
submit the appropriate forms as instructed on the forms no
later than sixty days after the event occurs.
For purposes of this section, an eligible dependent
includes any person who qualifies as a dependent of the
employee for tax purposes under IRC Section 152 without regard
to the income limitations of that section. It does not
include a Washington state registered domestic partner unless
the domestic partner otherwise qualifies as a dependent for
tax purposes under IRC Section 152.
(a) An employee may enroll or change his or her election
under the premium payment plan when any of the following
special open enrollment events occur, if the requested change
corresponds to and is consistent with the event. Enrollment
will be effective the first day of the month following the
later of the event date or the date the form is received.
(i) Employee acquires a new dependent due to:
• Marriage;
• Birth, adoption, or when the subscriber has assumed a
legal obligation for total or partial support in anticipation
of adoption;
• A child becoming eligible as an extended dependent
through legal custody or legal guardianship; or
• A child becoming eligible as a dependent with a
disability;
(ii) Employee or an employee's dependent loses other
coverage under a group health plan or through health insurance
coverage, as defined by the Health Insurance Portability and
Accountability Act (HIPAA);
(iii) Employee or an employee's dependent has a change in
employment status that affects the employee's or a dependent's
eligibility for the employer contribution toward group health
coverage;
(iv) Employee receives a court order or medical support
order requiring the employee or the employee's spouse to
provide insurance coverage for an eligible dependent;
(v) Employee or employee's dependent becomes eligible for
state premium assistance through medicaid or a state
children's health insurance program (CHIP), or the employee or
employee's dependent loses eligibility for coverage under
medicaid or CHIP;
(vi) Employee or employee's dependent gains or loses
eligibility for medicare;
(vii) Employee or employee's dependent's current health
plan becomes unavailable because the employee or enrolled
dependent is no longer eligible for a health savings account
(HSA). HCA may require evidence that the employee or
employee's dependent is no longer eligible for an HSA;
(viii) Employee experiences a disruption that could
function as a reduction in benefits for the employee or the
employee's dependent(s) due to a specific condition or ongoing
course of treatment. An employee may not change their health
plan if the employee's or an enrolled dependent's physician
stops participation with the employee's health plan unless the
PEBB program determines that a continuity of care issue
exists. The PEBB program criteria used will include, but is
not limited to, the following in determining if a continuity
of care issue exists:
(A) Active cancer treatment; or
(B) Recent transplant (within the last twelve months); or
(C) Scheduled surgery within the next sixty days; or
(D) Major surgery within the previous sixty days; or
(E) Third trimester of pregnancy; or
(F) Language barrier.
If the employee is having premiums taken from payroll on
a pretax basis, a plan change will not be approved if it would
conflict with provisions of the salary reduction plan
authorized under RCW 41.05.300.
(b) An employee may enroll or change his or her election
under the medical FSA when any one of the following special
open enrollment events occur, if the requested change
corresponds to and is consistent with the event. Enrollment
will be effective the first day of the month following
approval by the FSA administrator.
(i) Employee acquires a new dependent due to:
• Marriage;
• Birth, adoption, or when the subscriber has assumed a
legal obligation for total or partial support in anticipation
of adoption;
• A child becoming eligible as an extended dependent
through legal custody or legal guardianship; or
• A child becoming eligible as a dependent with a
disability;
(ii) Employee or an employee's dependent has a change in
employment status that affects the employee's or a dependent's
eligibility for the FSA;
(iii) Employee receives a court order or medical support
order requiring the employee or the employee's spouse to
provide insurance coverage for an eligible dependent;
(iv) Employee or an employee's dependent loses
eligibility for coverage under medicaid or a state children's
health insurance program (CHIP);
(v) Employee or an employee's dependent gains or loses
eligibility for medicare;
(c) An employee may enroll or change his or her election
under the DCAP when any one of the following special open
enrollment events occur, if the requested change corresponds
to and is consistent with the event. Enrollment will be
effective the first day of the month following approval by the
DCAP administrator.
(i) Employee acquires a new dependent due to:
• Marriage;
• Birth, adoption, or when the subscriber has assumed a
legal obligation for total or partial support in anticipation
of adoption;
• A child becoming eligible as an extended dependent
through legal custody or legal guardianship; or
• A child becoming eligible as a dependent with a
disability;
(ii) Employee or an employee's dependent has a change in
employment status that affects the employee's or a dependent's
eligibility for DCAP;
(iii) Employee changes dependent care provider; the
change to DCAP can reflect the cost of the new provider;
(iv) Employee or the employee's spouse experiences a
change in the number of qualifying individuals as defined in
IRC Section 21 (b)(1);
(v) Employee's dependent care provider imposes a change
in the cost of dependent care; employee may make a change in
the DCAP to reflect the new cost if the dependent care
provider is not a relative as defined in Section 152 (a)(1)
through (8), incorporating the rules of Section 152 (b)(1) and
(2) of the IRC.
[Statutory Authority: RCW 41.05.160 and 2011 c 8. 11-22-036
(Order 11-02), § 182-08-199, filed 10/26/11, effective 1/1/12.
Statutory Authority: RCW 41.05.160. 10-20-147 (Order
10-02), § 182-08-199, filed 10/6/10, effective 1/1/11;
09-23-102 (Order 09-02), § 182-08-199, filed 11/17/09,
effective 1/1/10; 08-20-128 (Order 08-03), § 182-08-199, filed
10/1/08, effective 1/1/09.]