WAC 182-12-262
When may subscribers enroll or remove
eligible dependents? (1) Enrolling dependents in health plan
coverage. A dependent must be enrolled in the same health
plan coverage as the subscriber, and the subscriber must be
enrolled to enroll his or her dependent except as provided in
WAC 182-12-205 (1)(c). Subscribers may enroll eligible
dependents at the following times:
(a) When the subscriber becomes eligible and enrolls in
PEBB insurance coverage. If eligibility is verified and the
dependent is enrolled, the dependent's effective date will be
the same as the subscriber's effective date.
(b) During the annual open enrollment. PEBB health plan
coverage begins January 1st of the following year.
(c) During special open enrollment. Subscribers may
enroll dependents during a special open enrollment as
described in subsection (3) of this section. The subscriber
must satisfy the enrollment requirements as described in
subsection (4) of this section.
(2) Removing dependents from a subscriber's health plan
coverage.
(a) Subscribers are required to remove a dependent within
sixty days of the date the dependent no longer meets the
eligibility criteria in WAC 182-12-250 or 182-12-260. Employees must notify their employing agency. All other
subscribers must notify the PEBB program. The PEBB program
will remove a subscriber's enrolled dependent the last day of
the month in which the dependent ceases to meet the
eligibility criteria. Consequences for not submitting notice
within sixty days of any dependent ceasing to be eligible may
include, but are not limited to:
(i) The dependent may lose eligibility to continue health
plan coverage under one of the continuation coverage options
described in WAC 182-12-270;
(ii) The subscriber may be billed for claims paid by the
health plan for services that were rendered after the
dependent lost eligibility;
(iii) The subscriber may not be able to recover
subscriber-paid insurance premiums for dependents that lost
their eligibility; and
(iv) The subscriber may be responsible for premiums paid
by the state for the dependent's health plan coverage after
the dependent lost eligibility.
(b) Employees have the opportunity to remove dependents:
(i) During the annual open enrollment. The dependent
will be removed the last day of December; or
(ii) During a special open enrollment as described in
subsection (3) of this section.
(c) Retirees, survivors, and enrollees with PEBB
continuation coverage under WAC 182-12-133, 182-12-141,
182-12-142, 182-12-146, or 182-12-148 may remove dependents
from their coverage outside of the annual open enrollment or a
special open enrollment by providing written notice to the
PEBB program. Unless otherwise approved by the PEBB program,
the dependent will be removed from the subscriber's coverage
prospectively.
(3) Special open enrollment. Subscribers may enroll or
remove their dependents outside of the annual open enrollment
if a special open enrollment event occurs. The change in
enrollment must correspond to the event that creates the
special open enrollment for either the subscriber or the
subscriber's dependents or both.
• Health plan coverage will begin the first of the month
following the later of the event date or the date the form is
received.
• Enrollment of extended dependents or dependents with a
disability will be the first day of the month following
eligibility certification.
• Dependents will be removed from the subscriber's health
plan coverage the last day of the month following the event.
• If the special open enrollment is due to the birth or
adoption of a child, or when the subscriber has assumed a
legal obligation for total or partial support in anticipation
of adoption of a child, health plan coverage will begin or end
the month in which the event occurs.
Any one of the following events may create a special open
enrollment:
(a) Subscriber acquires a new dependent due to:
(i) Marriage or registering a domestic partnership with
Washington's secretary of state;
(ii) Birth, adoption, or when a 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) Subscriber or a subscriber'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);
(c) Subscriber or a subscriber's dependent has a change
in employment status that affects the subscriber's or the
subscriber's dependent's eligibility for the employer
contribution toward group health coverage;
(d) Subscriber receives a court order or medical support
order requiring the subscriber, the subscriber's spouse, or
the subscriber's 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) Subscriber or a subscriber's dependent becomes
eligible for state premium assistance through medicaid or a
state children's health insurance program (CHIP), or the
subscriber or dependent loses eligibility for coverage under
medicaid or CHIP.
(4) Enrollment requirements. Subscribers must submit the
appropriate forms within the time frames described in this
subsection. Employees submit the appropriate forms to their
employing agency. All other subscribers submit the
appropriate forms to the PEBB program. In addition to the
appropriate forms indicating dependent enrollment, the
subscriber must provide the required documents as evidence of
the dependent's eligibility; or as evidence of the event that
created the special open enrollment.
(a) If a subscriber wants to enroll their eligible
dependent(s) when the subscriber becomes eligible to enroll in
PEBB benefits, the subscriber must include the dependent's
enrollment information on the appropriate forms that the
subscriber submits within the relevant time frame described in
WAC 182-08-197, 182-12-171, or 182-12-250.
(b) If a subscriber wants to enroll eligible dependents
during the annual open enrollment, the subscriber must submit
the appropriate forms no later than the last day of the annual
open enrollment.
(c) If a subscriber wants to enroll newly eligible
dependents, the subscriber must submit the appropriate
enrollment forms no later than sixty days after the dependent
becomes eligible except as provided in (d) of this subsection.
(d) If a subscriber wants to enroll a newborn or child
whom the subscriber has adopted or has assumed a legal
obligation for total or partial support in anticipation of
adoption, the subscriber should notify the PEBB program by
submitting an enrollment form as soon as possible to ensure
timely payment of claims. If adding the child increases the
premium, the subscriber must submit the appropriate enrollment
form no later than twelve months after the date of the birth,
adoption, or the date the legal obligation is assumed for
total or partial support in anticipation of adoption.
(e) If the subscriber wants to enroll a child age
twenty-six or older as a child with disabilities, the
subscriber must submit the appropriate form(s) no later than
sixty days after the last day of the month in which the child
reaches age twenty-six or within the relevant time frame
described in WAC 182-12-262 (4)(a), (b), and (f).
(f) If the subscriber wants to change a dependent's
enrollment status during a special open enrollment, the
subscriber must submit the appropriate forms no later than
sixty days after the event that creates the special open
enrollment.
[Statutory Authority: RCW 41.05.160 and 2011 c 8. 11-22-036
(Order 11-02), § 182-12-262, filed 10/26/11, effective 1/1/12.
Statutory Authority: RCW 41.05.160. 10-20-147 (Order
10-02), § 182-12-262, filed 10/6/10, effective 1/1/11;
09-23-102 (Order 09-02), § 182-12-262, filed 11/17/09,
effective 1/1/10; 08-20-128 (Order 08-03), § 182-12-262, filed
10/1/08, effective 1/1/09; 08-09-027 (Order 08-01), §
182-12-262, filed 4/8/08, effective 4/9/08.]