WAC 182-12-128   May an employee waive health plan enrollment?  Employees must enroll in dental, life and long-term disability insurance (unless the employing agency does not participate in these PEBB insurance coverages). However, employees may waive PEBB medical if they have other comprehensive group medical coverage.

     (1) Employees may waive enrollment in PEBB medical by submitting the appropriate enrollment form to their employing agency during the following times:

     (a) When the employee becomes eligible: Employees may waive medical when they become eligible for PEBB benefits. Employees must indicate they are waiving medical on the appropriate enrollment form they submit to their employing agency no later than thirty-one days after the date they become eligible (see WAC 182-08-197). Medical will be waived as of the date the employee becomes eligible for PEBB benefits.

     (b) During the annual open enrollment: Employees may waive medical during the annual open enrollment if they submit the appropriate enrollment form to their employing agency before the end of the annual open enrollment. Medical will be waived beginning January 1st of the following year.

     (c) During a special open enrollment: Employees may waive medical during a special open enrollment as described in subsection (4) of this section.

     (2) If an employee waives medical, the employee's eligible dependents may not be enrolled in medical.

     (3) Once medical is waived, enrollment is only allowed during the following times:

     (a) During the annual open enrollment;

     (b) During a special open enrollment created by an event that allows for enrollment outside of the annual open enrollment as described in subsection (4) of this section. In addition to the appropriate forms, the PEBB program may require the employee to provide evidence of eligibility and evidence of the event that creates a special open enrollment.

     (4) Special open enrollment: Employees may waive enrollment in medical or enroll in medical if a special open enrollment events occurs. The change in enrollment must correspond to the event that creates the special open enrollment. Any one of the following events may create a special open enrollment:

     (a) Employee acquires a new dependent due to:

     (i) Marriage or registering a domestic partnership with Washington state;

     (ii) Birth, adoption or when the subscriber has assumed a legal obligation for total or partial support in anticipation of adoption;

     (iii) A child becoming eligible as an extended dependent through legal custody or legal guardianship; or

     (iv) A child becoming eligible as a dependent with a disability;

     (b) Employee or a 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);

     (c) Employee or an employee's dependent has a change in employment status that affects the employee's or employee's dependent's eligibility for the employer contribution toward group health coverage;

     (d) Employee receives a court order or medical support order requiring the employee, spouse, or Washington state registered domestic partner to provide insurance coverage for an eligible dependent (a former spouse or former registered domestic partner is not an eligible dependent);

     (e) Employee or dependent becomes eligible for state premium assistance through medicaid or a state children's health insurance program (CHIP), or the employee or dependent loses eligibility for coverage under medicaid or CHIP.

     To waive or enroll during a special open enrollment, the employee must submit the appropriate forms to their employing agency no later than sixty days after the event that creates the special open enrollment.

     Medical will be waived the end of the month following the later of the event date or the date the form is received. If the special open enrollment is due to the birth, adoption or assumption of legal obligation for total or partial support in anticipation of adoption of a child, medical will be waived the first of the month in which the event occurs.

     Enrollment in medical will begin the first day of the month following the later of the event date or the date the form is received. If the special open enrollment is due to the birth, adoption or assumption of legal obligation for total or partial support in anticipation of adoption of a child, enrollment in medical will begin the first of the month in which the event occurs.



[Statutory Authority: RCW 41.05.160 and 2011 c 8. 11-22-036 (Order 11-02), § 182-12-128, filed 10/26/11, effective 1/1/12. Statutory Authority: RCW 41.05.160. 10-20-147 (Order 10-02), § 182-12-128, filed 10/6/10, effective 1/1/11; 09-23-102 (Order 09-02), § 182-12-128, filed 11/17/09, effective 1/1/10; 08-20-128 (Order 08-03), § 182-12-128, filed 10/1/08, effective 1/1/09; 08-09-027 (Order 08-01), § 182-12-128, filed 4/8/08, effective 4/9/08; 07-20-129 (Order 07-01), § 182-12-128, filed 10/3/07, effective 11/3/07. Statutory Authority: RCW 41.05.160 and 41.05.165. 04-18-039, § 182-12-128, filed 8/26/04, effective 1/1/05.]