WAC 182-12-250   Insurance coverage eligibility for survivors of emergency service personnel killed in the line of duty.  Surviving spouses, Washington state registered domestic partners, and dependent children of emergency service personnel who are killed in the line of duty are eligible to enroll in health plans administered by the PEBB program within HCA.

     (1) This section applies to the surviving spouse, the surviving Washington state registered domestic partner, and dependent children of emergency service personnel "killed in the line of duty" as determined by the Washington state department of labor and industries.

     (2) "Emergency service personnel" means law enforcement officers and firefighters as defined in RCW 41.26.030, members of the Washington state patrol retirement fund as defined in RCW 43.43.120, and reserve officers and firefighters as defined in RCW 41.24.010.

     (3) "Surviving spouse, Washington state registered domestic partner, and dependent children" means:

     (a) A lawful spouse;

     (b) An ex-spouse as defined in RCW 41.26.162;

     (c) A Washington state registered domestic partner as defined in RCW 26.60.020; and

     (d) Children. The term "children" includes children of the emergency service worker up to age twenty-six. Children with disabilities as defined in RCW 41.26.030(7) are eligible at any age. "Children" is defined as:

     (i) Biological children (including the emergency service worker's posthumous children);

     (ii) Stepchildren or children of a Washington state registered domestic partner; and

     (iii) Legally adopted children.

     (4) Surviving spouses, Washington state registered domestic partners, and children who are entitled to medicare must enroll in both parts A and B of medicare.

     (5) The survivor (or agent acting on their behalf) must submit the appropriate forms (to either enroll or defer enrollment in a PEBB health plan) to PEBB program no later than one hundred eighty days after the latter of:

     (a) The death of the emergency service worker;

     (b) The date on the letter from the department of retirement systems or the board for volunteer firefighters and reserve officers that informs the survivor that he or she is determined to be an eligible survivor;

     (c) The last day the surviving spouse, Washington state registered domestic partner, or child was covered under any health plan through the emergency service worker's employer; or

     (d) The last day the surviving spouse, Washington state registered domestic partner, or child was covered under the Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage from the emergency service worker's employer.

     (6) Survivors who do not choose to defer enrollment in a PEBB health plan may choose among the following options for when their enrollment in a PEBB health plan will begin:

     (a) June 1, 2006, for survivors whose appropriate forms are received by the PEBB program no later than September 1, 2006;

     (b) The first of the month that is not earlier than sixty days before the date that the PEBB program receives the appropriate forms (for example, if the PEBB program receives the appropriate forms on August 29, the survivor may request health plan enrollment to begin on July 1); or

     (c) The first of the month after the date that the PEBB program receives the appropriate forms.

     For surviving spouses, Washington state registered domestic partners, and children who enroll, monthly health plan premiums must be paid by the survivor except as provided in RCW 41.26.510(5) and 43.43.285 (2)(b).

     (7) Survivors must choose one of the following two options to maintain eligibility for PEBB insurance coverage:

     (a) Enroll in a PEBB health plan:

     (i) Enroll in medical; or

     (ii) Enroll in medical and dental.

     (iii) Survivors enrolling in dental must stay enrolled in dental for at least two years before dental can be dropped.

     (iv) Dental only is not an option.

     (b) Defer enrollment:

     (i) Survivors may defer enrollment in a PEBB health plan if enrolled in comprehensive employer sponsored medical.

     (ii) Survivors may enroll in a PEBB health plan when they lose comprehensive employer sponsored medical. Survivors will need to provide evidence that they were continuously enrolled in comprehensive employer sponsored medical when applying for a PEBB health plan, and apply within sixty days after the date their other coverage ended.

     (iii) PEBB health plan enrollment and premiums will begin the first day of the month following the day that the other coverage ended for eligible spouses and children who enroll.

     (8) Survivors may change their health plan during annual open enrollment. In addition to annual open enrollment, survivors may change health plans as described in WAC 182-08-198.

     (9) Survivors will lose their right to enroll in a PEBB health plan if they:

     (a) Do not apply to enroll or defer PEBB health plan enrollment within the timelines stated in subsection (5) of this section; or

     (b) Do not maintain continuous enrollment in comprehensive employer sponsored medical through an employer during the deferral period, as provided in subsection (7)(b)(i) of this section.



[Statutory Authority: RCW 41.05.160 and 2011 c 8. 11-22-036 (Order 11-02), § 182-12-250, filed 10/26/11, effective 1/1/12. Statutory Authority: RCW 41.05.160. 10-20-147 (Order 10-02), § 182-12-250, filed 10/6/10, effective 1/1/11; 09-23-102 (Order 09-02), § 182-12-250, filed 11/17/09, effective 1/1/10; 08-20-128 (Order 08-03), § 182-12-250, filed 10/1/08, effective 1/1/09; 07-20-129 (Order 07-01), § 182-12-250, filed 10/3/07, effective 11/3/07. Statutory Authority: RCW 41.05.160 and 41.05.080. 06-20-099 (Order 06-08), § 182-12-250, filed 10/3/06, effective 11/3/06. Statutory Authority: RCW 41.05.160 and 41.05.165. 04-18-039, § 182-12-250, filed 8/26/04, effective 1/1/05.]