reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-123 - Is dual enrollment in public employees benefits board (PEBB) and school employees benefits board (SEBB) prohibited?

Current through Register Vol. 24-14, July 15, 2024
Public employees benefits board (PEBB) medical and dental
				  coverage is limited to a single enrollment per individual as described in
				  subsections (1) through (5) of this section. Effective January 1, 2022,
				  individuals are limited to a single enrollment in medical, dental, and vision
				  plans in either the PEBB program or school employees benefits board (SEBB)
				  program as described in subsection (6) of this section.
(1) An individual who has more than one
				source of eligibility for enrollment in PEBB medical and PEBB dental coverage
				(called "dual eligibility") is limited to one enrollment.
(2) An eligible employee may waive PEBB
				medical and enroll as a dependent under the PEBB medical plan of their spouse,
				state registered domestic partner, or parent as described in WAC
				182-12-128.
(3) A dependent enrolled in PEBB medical or
				PEBB dental who becomes eligible for PEBB benefits as an employee must elect to
				enroll in PEBB benefits as described in WAC
				182-08-197(1) or
				(3). This includes making an election to
				enroll in or waive enrollment in PEBB medical as described in WAC
				182-12-128.
(a) If the employee does not waive enrollment
				in PEBB medical, the employee is not eligible to remain enrolled in their
				spouse's, state registered domestic partner's, or parent's PEBB medical as a
				dependent. If the employee's spouse, state registered domestic partner, or
				parent does not take action to remove the employee (who is enrolled as a
				dependent) from their subscriber account, the PEBB program will automatically
				disenroll the employee's enrollment as a dependent the last day of the month
				before the employee's enrollment in PEBB benefits begins as described in WAC
				182-12-114.
Exception:
An enrolled dependent who becomes newly eligible for
							 PEBB benefits as an employee may be dual-enrolled in PEBB medical and dental
							 for one month. This exception is only allowed for the first month the dependent
							 is enrolled as an employee, and only if the dependent becomes enrolled as an
							 employee on the first working day of a month that is not the first day of the
							 month.
(b)
				If the employee elects to waive their enrollment in PEBB medical, the employee
				will remain enrolled in PEBB medical under their spouse's, state registered
				domestic partner's, or parent's PEBB medical as a dependent.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-129 - What happens when an employee moves from an eligible to an otherwise ineligible position or job due to a layoff?

Current through Register Vol. 24-14, July 15, 2024
This section applies to employees employed by state agencies
				  (as defined in this chapter), including benefits-eligible seasonal employees,
				  and is intended to address situations where an employee moves from one position
				  or job to another due to a layoff, as described in WAC
				  182-12-109. This section does not
				  apply to employees with an anticipated end date.
If an employee moves from an eligible to an otherwise
				  ineligible position due to layoff, the employee may retain their eligibility
				  for the employer contribution toward public employees benefits board (PEBB)
				  benefits for each month that the employee is in pay status for at least eight
				  hours. To maintain eligibility using this section the employee must:
* Be hired into a position with a state agency within 24
				  months of the original eligible position ending; and
* Upon hire, notify the employing state agency that they are
				  potentially eligible to use this section.
This section ceases to apply when the employee is employed in
				  a position eligible for PEBB benefits under WAC
				  182-12-114 or at the end of the
				  24th month after the original eligible position ended, whichever occurs
				  first.
Statutory
				  Authority:
				  RCW
				  41.05.160 and
				  2012 2nd sp.s. c
				  3 . WSR 13-22-019 (Admin. 2013-01), §
										182-12-129, filed 10/28/13,
				  effective 1/1/14. Statutory Authority:
				  RCW
				  41.05.160. WSR 09-23-102 (Order 09-02),
				  §
										182-12-129, filed 11/17/09,
				  effective 1/1/10. WSR 13-21-033, §
										182-12-129, filed 10/9/2013,
				  effective 11/9/2013
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-131 - How do eligible employees maintain the employer contribution toward public employees benefits board (PEBB) benefits?

Current through Register Vol. 24-14, July 15, 2024
The employer contribution toward public employees benefits
				  board (PEBB) benefits begins as described in WAC
				  182-12-114.
				  This section describes under what circumstances employees maintain eligibility
				  for the employer contribution toward PEBB benefits.
(1)
Maintaining the employer
				contribution.
Except as described in subsections (2), (3), and (4) of
				this section, employees who have established eligibility for benefits as
				described in WAC
				182-12-114
				are eligible for the employer contribution each month in which they are in pay
				status eight or more hours per month.
(2)
Maintaining the employer
				contribution - Benefits-eligible seasonal employees.
(a) Benefits-eligible seasonal employees
				(eligible as described in WAC
				182-12-114(2)
				) who work a season of less than nine months are eligible for the employer
				contribution in any month of the season in which they are in pay status eight
				or more hours during that month. The employer contribution toward PEBB benefits
				for seasonal employees returning after their off season begins on the first day
				of the first month of the season in which they are in pay status eight hours or
				more.
(b) Benefits-eligible
				seasonal employees (eligible as described in WAC
				182-12-114(2)
				) who work a season of nine months or more are eligible for the employer
				contribution:
(i) In any month of the season
				in which they are in pay status eight or more hours during that month;
				and
(ii) Through the off season
				following each season worked, but the eligibility may not exceed a total of
				twelve consecutive calendar months for the combined season and off
				season.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-136 - May employees on approved educational leave waive continuation coverage?

Current through Register Vol. 24-14, July 15, 2024
In order to avoid duplication of group health plan coverage,
				  the following shall apply to employees during any period of approved
				  educational leave. Employees eligible for continuation coverage provided in WAC
				  182-12-133 who obtain other
				  employer-based group medical or dental , or both, may waive continuation of
				  such coverage for each full calendar month in which they maintain coverage
				  under the other employer-based medical or dental. These employees have the
				  right to reenroll in a public employees benefits board (PEBB) health plan
				  effective the first day of the month after the date the other employer-based
				  group medical or dental ends, provided evidence of such other coverage is
				  provided to the PEBB program upon application for
				  reenrollment.
Statutory Authority:
					 RCW
					 41.05.160. 09-23-102 (Order 09-02), §
											182-12-136, filed 11/17/09,
					 effective 1/1/10; 07-20-129 (Order 07-01), §
											182-12-136, filed 10/3/07,
					 effective 11/3/07. Statutory Authority:
					 RCW
					 41.05.160 and
					 41.05.165. 04-18-039, §
											182-12-136, filed 8/26/04,
					 effective 1/1/05.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-138 - What options are available if an employee is approved for the federal Family and Medical Leave Act (FMLA) or the paid family and medical leave program?

Current through Register Vol. 24-14, July 15, 2024
(1) An employee on
				approved leave under the federal Family and Medical Leave Act (FMLA) may
				continue to receive the employer contribution toward public employees benefits
				board (PEBB) benefits in accordance with the federal FMLA. The employee may
				also continue current supplemental life, supplemental accidental death and
				dismemberment (AD&D), and employee-paid longterm disability (LTD)
				insurance. The employee's employing agency is responsible for determining if
				the employee is eligible for leave under FMLA and the duration of such
				leave.
(2) An employee on approved
				leave under the paid family and medical leave program under chapter 50A.05 RCW
				may continue to receive the employer contribution toward PEBB benefits in
				accordance with
				RCW
				50A.35.020. The employee may also continue
				current supplemental life, supplemental AD&D, and employee-paid LTD
				insurance. The employment security department is responsible for determining if
				the employee is eligible for the paid family and medical leave
				program.
(3) If an employee
				exhausts the period of leave approved under FMLA or paid family and medical
				leave, PEBB insurance coverage may be continued by self-paying the premium and
				applicable premium surcharges set by the HCA, with no contribution from the
				employing agency as described in WAC
				182-12-133(1).
Statutory Authority:
					 RCW
					 41.05.160. 12-20-022 (Order 2012-01), §
											182-12-138, filed 9/25/12,
					 effective 11/1/12. Statutory Authority:
					 RCW
					 41.05.160 and
					 2011 c
					 8 . 11-22-036 (Order 11-02), §
											182-12-138, filed 10/26/11,
					 effective 1/1/12. Statutory Authority:
					 RCW
					 41.05.160. 09-23-102 (Order 09-02), §
											182-12-138, filed 11/17/09,
					 effective 1/1/10; 08-20-128 (Order 08-03), §
											182-12-138, filed 10/1/08,
					 effective 1/1/09; 07-20-129 (Order 07-01), §
											182-12-138, filed 10/3/07,
					 effective 11/3/07. Statutory Authority:
					 RCW
					 41.05.160 and
					 41.05.165. 04-18-039, §
											182-12-138, filed 8/26/04,
					 effective 1/1/05.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-141 - If an employee reverts from an eligible position, what happens to their public employees benefits board (PEBB) insurance coverage?

Current through Register Vol. 24-14, July 15, 2024
(1) If an employee
				reverts for reasons other than a layoff and is not eligible for the employer
				contribution toward public employees benefits board (PEBB) benefits under this
				chapter, they may continue PEBB insurance coverage by self-paying the premium
				and applicable premium surcharge set by the health care authority (HCA) for up
				to eighteen months under the same terms as an employee who is granted leave
				without pay under WAC
				182-12-133(1):
(a) The employee's election must be received
				by the PEBB program no later than sixty days from the date the employee's PEBB
				health plan coverage ended or from the postmark date on the election notice
				sent by the PEBB program, whichever is later;
(b) The employee's first premium payment and
				applicable premium surcharges are due to the HCA no later than forty-five days
				after the election period ends as described in (a) of this subsection. Premiums
				and applicable premium surcharges associated with continuing PEBB medical must
				be made to the HCA as well as premiums associated with continuing PEBB dental.
				Premiums associated with continuing life insurance and accidental death and
				dismemberment insurance coverage must be made to the contracted
				vendor;
(c) Following the
				employee's first premium payment, the employee must pay the premium amounts
				associated with PEBB insurance coverage and applicable premium surcharges as
				premiums become due; and
(d) If the
				employee's monthly premium or applicable premium surcharges remain unpaid for
				sixty days from the original due date, the employee's PEBB insurance coverage
				will be terminated retroactive to the last day of the month for which the
				monthly premium and applicable premium surcharges were paid as described in WAC
				182-08-180(1)(c).
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-142 - What options for continuation coverage are available to faculty and seasonal employees who are between periods of eligibility?

Current through Register Vol. 24-14, July 15, 2024
(1)
Faculty
may continue any
				combination of medical or dental, and may also continue life insurance and
				accidental death and dismemberment (AD&D) insurance by self-paying the
				premium and applicable premium surcharges set by the health care authority
				(HCA), with no contribution from the employer, for a maximum of twelve months
				between periods of eligibility. If life insurance or AD&D insurance is
				elected, both basic life and basic AD&D insurance must be continued.
				Employees who continue basic life insurance and basic AD&D insurance may
				also continue supplemental life and AD&D insurance:
(a) The employee's election must be received
				by the public employees benefits board (PEBB) program no later than sixty days
				from the date the employee's PEBB health plan coverage ended or from the
				postmark date on the election notice sent by the PEBB program, whichever is
				later;
(b) The employee's first
				premium payment and applicable premium surcharges are due to the HCA no later
				than forty-five days after the election period ends as described in (a) of this
				subsection. Premiums and applicable premium surcharges associated with
				continuing PEBB medical must be made to the HCA as well as premiums associated
				with continuing PEBB dental. Premiums associated with continuing life insurance
				and AD&D insurance coverage must be made to the contracted
				vendor;
(c) Following the
				employee's first premium payment, the employee must pay the premium amounts
				associated with PEBB insurance coverage and applicable premium surcharges as
				premiums become due; and
(d) If the
				employee's monthly premium or applicable premium surcharges remain unpaid for
				sixty days from the original due date, the employee's PEBB insurance coverage
				will be terminated retroactive to the last day of the month for which the
				monthly premium and applicable premium surcharges were paid as described in WAC
				182-08-180(1)(c).
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-148 - What options for continuation coverage are available to employees during their appeal of dismissal?

Current through Register Vol. 24-14, July 15, 2024
(1) Employees
				awaiting the hearing outcome of a dismissal action before any of the following
				may continue their public employees benefits board (PEBB) insurance coverage by
				self-paying the premium and applicable premium surcharges set by the health
				care authority (HCA), with no contribution from the employer, on the same terms
				as an employee who is granted leave as described in WAC 182-12133:
(a) The personnel resources board;
(b) An arbitrator;
(c) A grievance or appeals committee
				established under a collective bargaining agreement for union represented
				employees; or
(d) A
				court.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-180 - When is an elected and full-time appointed official of the legislative and executive branch of state government, or their survivor eligible to continue enrollment in public employees benefits board (PEBB) retiree insurance coverage?

Current through Register Vol. 24-14, July 15, 2024
(1) An elected and
				full-time appointed official of the legislative and executive branch of state
				government is eligible to continue enrollment or defer enrollment in public
				employees benefits board (PEBB) retiree insurance coverage under the same terms
				as an outgoing legislator, when they voluntarily or involuntarily leave public
				office. The following officials are eligible if they meet the procedural
				requirements as described in subsection (3) of this section:
(a) A member of the state
				legislature;
(b) A statewide
				elected official of the executive branch;
(c) An executive official appointed directly
				by the governor as the single head of an executive branch agency; or
(d) An official appointed directly by a state
				legislative committee as the single head of a legislative branch agency or an
				official appointed to secretary of the senate or chief clerk of the house of
				representatives.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-205 - May a retiree or a survivor defer enrollment or voluntarily terminate enrollment under public employees benefits board (PEBB) retiree insurance coverage?

Current through Register Vol. 24-14, July 15, 2024
(1) The following
				individuals may defer enrollment in public employees benefits board (PEBB)
				retiree insurance coverage:
(a) A retiring
				employee or a retiring school employee;
(b) A dependent becoming eligible as a
				survivor; or
(c) A retiree or a
				survivor enrolled in PEBB retiree insurance coverage.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-207 - When can a retiree or an eligible dependent's public employees benefits board (PEBB) insurance coverage be terminated by the health care authority (HCA)?

Current through Register Vol. 24-14, July 15, 2024
A retiree or an eligible dependent's public employees
				  benefits board (PEBB) insurance coverage can be terminated by the health care
				  authority (HCA) for the following reasons:
(1) Failure to comply with the PEBB program's
				procedural requirements, including failure to provide information or
				documentation requested by the due date in written requests from the PEBB
				program;
(2) Knowingly providing
				false information;
(3) Failure to
				pay the monthly premium or applicable premium surcharges when due as described
				in WAC
				182-08-180(1)(c);
(4) Misconduct. If a retiree's PEBB insurance
				coverage is terminated for misconduct, PEBB retiree insurance coverage will not
				be reinstated at a later date. Examples of such termination include, but are
				not limited to the following:
(a) Fraud,
				intentional misrepresentation or withholding of information the subscriber knew
				or should have known was material or necessary to accurately determine
				eligibility or the correct premium; or
(b) Abusive or threatening conduct repeatedly
				directed to an HCA employee, a health plan or other HCA contracted vendor
				providing PEBB insurance coverage on behalf of the HCA, its employees, or other
				persons.
If a retiree's PEBB insurance coverage is terminated by HCA
				  for the above reasons, PEBB insurance coverage for all of the retiree's
				  eligible dependents is also terminated.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-208

Current through Register Vol. 24-14, July 15, 2024
Statutory
				  Authority:
				  RCW
				  41.05.160 and
				  2012 2nd sp.s. c
				  3 . WSR 13-22-019 (Admin. 2013-01), §
										182-12-208, filed 10/28/13,
				  effective 1/1/14. Statutory Authority:
				  RCW
				  41.05.160 and
				  2011 c
				  8 . WSR 11-22-036 (Order 11-02), §
										182-12-208, filed 10/26/11,
				  effective 1/1/12. Statutory Authority:
				  RCW
				  41.05.160. WSR 09-23-102 (Order 09-02),
				  §
										182-12-208, filed 11/17/09,
				  effective 1/1/10; WSR 07-20-129 (Order 07-01), §
										182-12-208, filed 10/3/07,
				  effective 11/3/07. WSR 13-21-033, §
										182-12-208, filed 10/9/2013,
				  effective 11/9/2013
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-209 - Who is eligible for retiree term life insurance?

Current through Register Vol. 24-14, July 15, 2024
Eligible employees who participate in public employees
				  benefits board (PEBB) life insurance as an employee and eligible school
				  employees who participate in school employees benefits board (SEBB) life
				  insurance as an employee and meet qualifications for PEBB retiree insurance
				  coverage as provided in WAC
				  182-12-171
				  or
				  182-12-180,
				  are eligible for retiree term life insurance. They must submit the required
				  forms to the PEBB program. Forms for a retiring employee or a retiring school
				  employee as described in WAC
				  182-12-171,
				  must be received by the PEBB program no later than sixty days after the date
				  their PEBB or SEBB employee basic life insurance ends. Forms for an official
				  leaving public office as described in WAC
				  182-12-180,
				  must be received by the PEBB program no later than sixty days after the
				  official leaves public office.
(1)
				Employees or school employees whose life insurance premiums are being waived
				under the terms of the life insurance contract are not eligible for retiree
				term life insurance until their waiver of premium benefit ends.
(2) Retirees may not defer enrollment in
				retiree term life insurance, except as allowed in subsection (3)(b) of this
				section.
(3) If a retiree returns
				to active employment status and becomes eligible for the employer contribution
				toward PEBB or SEBB employee basic life insurance, they may choose:
(a) To continue to self-pay premiums and keep
				retiree term life insurance, the employee or the school employee must pay
				retiree term life insurance premiums directly to the contracted vendor during
				the period they are eligible for PEBB or SEBB employee basic life insurance;
				or
(b) To stop self-paying retiree
				term life insurance premiums during the period they are eligible for PEBB or
				SEBB employee basic life insurance and elect retiree term life insurance when
				PEBB or SEBB employee basic life insurance ends.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-211 - May an employee or a school employee who is determined to be retroactively eligible for disability retirement enroll or defer enrollment in public employees benefits board (PEBB) retiree insurance coverage?

Current through Register Vol. 24-14, July 15, 2024
(1) An employee or
				a school employee who is determined to be retroactively eligible for a
				disability retirement is eligible to enroll or defer enrollment (as described
				in WAC
				182-12-200
				or
				182-12-205)
				in public employees benefits board (PEBB) retiree insurance coverage if:
(a) The employee or the school employee
				submits the required form and a copy of the formal determination letter they
				received from the Washington state department of retirement systems (DRS) or
				the appropriate higher education authority;
(b) The employee's or the school employee's
				form and a copy of their Washington state-sponsored retirement system's formal
				determination letter are received by the PEBB program no later than 60 days
				after the date on the determination letter; and
(c) The employee or the school employee
				immediately begins to receive a monthly pension benefit or a supplemental
				retirement plan benefit under their higher education retirement plan (HERP),
				with exceptions described below from WAC
				182-12-171(2):
(i) A retiring employee of a state agency, an
				employer group participating under a Washington state sponsored retirement
				plan, or a retiring school employee who receives a lump sum payment instead of
				a monthly retirement plan payment is only eligible if the department of
				retirement systems offered the employee the choice between a lump sum
				actuarially equivalent payment and the ongoing monthly payment, as allowed by
				the plan; or
(ii) A retiring
				employee of a state agency, an employer group participating under a Washington
				state sponsored retirement plan, or a retiring school employee who is a member
				of a Plan 3 retirement plan, also called a separated employee (defined in
				RCW
				41.05.011(25)) , must meet
				their Plan 3 retirement eligibility criteria. The employee or the school
				employee does not have to receive a retirement plan payment to enroll in PEBB
				retiree insurance coverage; or
(iii) A retiring employee of a Washington
				higher education institution who is a member of a higher education retirement
				plan (HERP) must immediately begin to receive a monthly retirement plan
				payment, or meet their HERP plan's retirement eligibility criteria, or be at
				least age 55 with 10 years of state service.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-250 - Public employees benefits board (PEBB) insurance coverage eligibility for survivors of emergency service personnel killed in the line of duty

Current through Register Vol. 24-14, July 15, 2024
Surviving spouses, state registered domestic partners, and
				  dependent children of emergency service personnel who are killed in the line of
				  duty are eligible to enroll or defer enrollment in public employees benefits
				  board (PEBB) retiree insurance coverage.
(1) This section applies to the surviving
				spouse, the surviving 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, 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 state registered domestic partner as
				defined in
				RCW
				26.60.020(1); and
(d) Children. The term "children" includes
				children of the emergency service worker up to age 26. Children with
				disabilities as defined in
				RCW
				41.26.030(6) 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 state registered domestic partner;
(iii) Legally adopted children;
(iv) Children for whom the subscriber has
				assumed a legal obligation for total or partial support in anticipation of
				adoption of the child;
(v) Children
				specified in a court order or divorce decree; or
(vi) Children as defined in
				RCW
				26.26A.100.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-262 - When may subscribers enroll or remove eligible dependents?

Current through Register Vol. 24-14, July 15, 2024
(1)
Enrolling
				dependents in public employees benefits board (PEBB) health plan coverage,
				supplemental dependent life insurance, and accidental death and dismemberment
				(AD&D) insurance.
A dependent must be enrolled in the same health
				plan coverage as the subscriber except as described in WAC
				182-12-171(1)(c).
				The subscriber must be enrolled in health plan coverage to enroll their
				dependent in health plan coverage except as provided in WAC
				182-12-205(3)(c).
				A dependent with more than one source of eligibility for enrollment in the PEBB
				and school employees benefits board (SEBB) programs is limited to a single
				enrollment in medical, dental, and vision plans in either the PEBB or SEBB
				program. Subscribers must satisfy the enrollment requirements as described in
				subsection (4) of this section and may enroll eligible dependents at the
				following times:
(a)
When the
				subscriber becomes eligible
and enrolls in PEBB benefits. If eligibility
				is verified the dependent's effective date will be as follows:
(i) PEBB health plan coverage will be the
				same as the subscriber's effective date;
(ii) Supplemental dependent life insurance or
				AD&D insurance, if elected, will be effective the first day of the month
				following the date the contracted vendor receives the required form or approves
				the enrollment. A newly born child must be at least 14 days old before
				supplemental dependent life insurance or AD&D insurance coverage is
				effective.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-263 - National Medical Support Notice (NMSN)

Current through Register Vol. 24-14, July 15, 2024
(1) When a National
				Medical Support Notice (NMSN) requires a subscriber to provide health plan
				coverage for a dependent child the following provisions apply:
(a) The subscriber may enroll their dependent
				child and request changes to their health plan coverage as described under
				subsection (c) of this section. Employees submit the required forms to their
				employing agency. Subscribers on continuation coverage or PEBB retiree
				insurance coverage submit the required forms to the public employees benefits
				board (PEBB) program.
(b) If the
				subscriber fails to request enrollment or health plan coverage changes as
				directed by the NMSN, the employing agency or the PEBB program may make
				enrollment or health plan coverage changes according to (c) of this subsection
				upon request of:
(i) The child's other
				parent; or
(ii) Child support
				enforcement program.
(c)
				Changes to health plan coverage or enrollment are allowed as directed by the
				NMSN:
(i) The dependent will be enrolled
				under the subscriber's health plan coverage as directed by the NMSN;
(ii) An employee who has waived PEBB medical
				under WAC
				182-12-128
				will be enrolled in medical as directed by the NMSN, in order to enroll the
				dependent;
(iii) The subscriber's
				selected health plan will be changed if directed by the NMSN;
(iv) If the dependent is already enrolled
				under another PEBB subscriber, the dependent will be removed from the other
				health plan coverage and enrolled as directed by the NMSN;
(v) If the dependent is enrolled in both
				school employees benefits board medical and PEBB medical as a dependent as
				described in WAC
				182-12-123(6)
				(g) and there is a NMSN in place, enrollment
				will be in accordance with the NMSN; or
(vi) If the subscriber is eligible for and
				elects Consolidated Omnibus Budget Reconciliation Act (COBRA) or other
				continuation coverage, the NMSN will be enforced and the dependent must be
				covered in accordance with the NMSN.
(d) Changes to health plan coverage or
				enrollment as described in (c)(i) through (iii) of this subsection will begin
				the first day of the month following receipt by the employing agency of the
				NMSN. If the NMSN is received by the employing agency on the first day of the
				month, the change to health plan coverage or enrollment begins on that day. A
				dependent will be removed from the subscriber's health plan coverage as
				described in (c)(iv) of this subsection the last day of the month the NMSN is
				received. If that day is the first of the month, the change in enrollment will
				be made the last day of the previous month.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-300 - Public employees benefits board (PEBB) wellness incentive program eligibility and procedural requirements

Current through Register Vol. 24-14, July 15, 2024
The board annually determines the design of the PEBB wellness
				  incentive program.
(1) All
				subscribers, except PEBB subscribers who are enrolled in both medicare Parts A
				and B, and in the medicare risk pool as described in
				RCW
				41.05.080(3), are eligible
				to participate in the PEBB well-ness incentive program.
(2) Effective January 1, 2020, to receive the
				PEBB wellness incentive of a reduction to the subscriber's medical plan
				deductible or a deposit to the subscriber's health savings account for the
				following plan year, eligible subscribers must complete PEBB wellness incentive
				program requirements during the current plan year by the following deadline:
(a) For subscribers continuing enrollment in
				PEBB medical and subscribers enrolling in PEBB medical with an effective date
				in January through September, the deadline is November 30th; or
(b) For subscribers enrolling in PEBB medical
				with an effective date in October through December, the deadline is December
				31st.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-13 - State resident-Medicare supplement › Section 182-13-010 - Purpose

Current through Register Vol. 24-14, July 15, 2024
The purpose of this chapter is to establish criteria for
				  state residents for participation in medicare supplemental coverage available
				  through the HCA.
Statutory Authority:
					 RCW
					 41.05.197. 95-07-011, §
											182-13-010, filed 3/3/95,
					 effective 4/3/95.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-13 - State resident-Medicare supplement › Section 182-13-020 - Definitions

Current through Register Vol. 24-14, July 15, 2024
Unless otherwise specifically provided, the definitions
				  contained in this section apply throughout this chapter.
(1) "HCA" means the Washington state health
				care authority.
(2) "Health plan,"
				or "plan" means any individual or group: Policy, agreement, or other contract
				providing coverage for medical, surgical, hospital, or emergency care services,
				whether issued, or issued for delivery, in Washington or any other state.
				"Health Plan" or "plan" also includes any group health plan that is maintained
				by any state and governed by the Public Health Services Act in 42 U.S.C.
				Chapter 6A, self-insured coverage governed by the federal Employee Retirement
				Income Security Act of 1974, coverage through the Washington state health
				insurance pool as described in chapter 48.41 RCW, coverage through the medicaid
				program as described in Title 74 RCW, and coverage through the Washington state
				health benefit exchange as described in chapter 43.71 RCW. "Health plan" or
				"plan" does not mean or include: Hospital confinement indemnity coverage as
				described in WAC
				284-50-345;
				disability income protection coverage as described in WAC
				284-50-355;
				accident only coverage as described in WAC
				284-50-360;
				specified disease and specified accident coverage as described in WAC
				284-50-365;
				limited benefit health insurance coverage as described in WAC
				284-50-370;
				long-term care benefits as described in chapter 48.84 RCW; or limited health
				care coverage (e.g., dental only).
(3) "Lapse in coverage" means a period of
				time greater than sixty-three continuous days without coverage by a health
				plan.
(4) "Resident" means a person
				who demonstrates that they live in the state of Washington by providing
				evidence of residency.
Statutory Authority:
					 RCW
					 41.05.197. 95-07-011, §
											182-13-020, filed 3/3/95,
					 effective 4/3/95.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-13 - State resident-Medicare supplement › Section 182-13-030 - Eligibility

Current through Register Vol. 24-14, July 15, 2024
A resident is eligible to apply for medicare supplemental
				  coverage available through the HCA provided the resident is:
(1) Enrolled in Parts A and B of medi-care;
				and
(2) Not eligible to purchase
				coverage as a retired or disabled employee under
				RCW
				41.05.195.
Statutory Authority:
					 RCW
					 41.05.197. 95-07-011, §
											182-13-030, filed 3/3/95,
					 effective 4/3/95.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-13 - State resident-Medicare supplement › Section 182-13-040 - Application for medicare supplemental coverage

Current through Register Vol. 24-14, July 15, 2024
Residents meeting eligibility requirements may apply for
				  medicare supplemental coverage available through the HCA:
(1) No earlier than thirty days before they
				are enrolled in both Parts A and B of medicare;
(2) Within sixty-three days after becoming a
				resident
of Washington state;
(3) During any open enrollment period
				established by federal or state law;
(4) During any open enrollment period
				established by the HCA subsequent to the initial open enrollment period
				provided that the applicant is replacing a health plan with no lapse in
				coverage; or
(5) When replacing
				coverage as described in
				RCW
				48.66.045 or when enrolling during a
				guaranteed issue period as described in
				RCW
				48.66.055.
Statutory Authority:
					 RCW
					 41.05.197. 95-07-011, §
											182-13-040, filed 3/3/95,
					 effective 4/3/95.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-010 - Purpose

Current through Register Vol. 24-14, July 15, 2024
This chapter describes the general rules and procedures
					 that apply to the health care authority's brief adjudicative proceedings and
					 formal administrative hearings for the public employees benefits board
					 program.
Statutory Authority:
						RCW
						41.05.160. 12-20-022 (Order 2012-01), §
												182-16-010, filed 9/25/12,
						effective 11/1/12; 08-20-128 (Order 08-03), §
												182-16-010, filed 10/1/08,
						effective 1/1/09. Statutory Authority: RCW 41.05.010 and
						34.05.250. 91-14-025, §
												182-16-010, filed 6/25/91,
						effective 7/26/91.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-025 - Where do members appeal decisions regarding eligibility, enrollment, premium payments, premium surcharges, a public employees benefits board (PEBB) wellness incentive, or the administration of benefits?

Current through Register Vol. 24-14, July 15, 2024
(1) Any current or former employee of a state
				  agency or his or her dependent aggrieved by a decision made by the employing
				  state agency with regard to public employees benefits board (PEBB) eligibility,
				  enrollment, or premium surcharge may appeal that decision to the employing
				  state agency by the process outlined in WAC
				  182-16-030.
Note:
Eligibility decisions address whether a subscriber
								or a subscriber's dependent is entitled to PEBB insurance coverage, as
								described in PEBB rules and policies. Enrollment decisions address the
								application for PEBB benefits as described in PEBB rules and policies
								including, but not limited to, the submission of proper documentation and
								meeting enrollment deadlines.
(2) Any current or former employee of an
				  employer group or his or her dependent who is aggrieved by a decision made by
				  an employer group with regard to PEBB eligibility, enrollment, or premium
				  surcharge may appeal that decision to the employer group through the process
				  established by the employer group.
Exception:
Any current or former employee of an employer group
								aggrieved by a decision regarding life insurance, long-term disability (LT D )
								insurance, eligibility to participate in the PEBB wellness incentive program,
								or eligibility to receive a PEBB wellness incentive may appeal that decision to
								the PEBB appeals committee by the process described in WAC
								182-16-032.
(3) Any subscriber or dependent aggrieved by
				  a decision made by the PEBB program with regard to PEBB eligibility,
				  enrollment, premium payments, premium surcharge, eligibility to participate in
				  the PEBB wellness incentive program, or eligibility to receive a PEBB wellness
				  incentive, may appeal that decision to the PEBB appeals committee by the
				  process described in WAC
				  182-16-032.
(4) Any PEBB enrollee aggrieved by a decision
				  regarding the administration of a health plan, life insurance, LTD insurance,
				  long-term care insurance, or property and casualty insurance may appeal that
				  decision by following the appeal provisions of those plans, with the exception
				  of :
(a) Enrollment decisions;
(b) Premium payment decisions other than life
				  insurance premium payment decisions; and
(c) Eligibility decisions.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-030 - How can a current or former employee or an employee's dependent appeal a decision made by a state agency about eligibility, premium surcharge, or enrollment in benefits?

Current through Register Vol. 24-14, July 15, 2024
(1) An eligibility,
				  premium surcharge, or enrollment decision made by an employing state agency may
				  be appealed by submitting a written request for review to the employing state
				  agency. The employing state agency must receive the request for review no later
				  than thirty days after the date of the initial denial notice. The contents of
				  the request for review are to be provided as described in WAC
				  182-16-040.
(a) Upon receiving the request for review,
				  the employing state agency shall make a complete review of the initial denial
				  by one or more staff who did not take part in the initial denial. As part of
				  the review, the employing state agency may hold a formal meeting or hearing,
				  but is not required to do so.
(b)
				  The employing state agency shall render a written decision within thirty days
				  of receiving the request for review. The written decision shall be sent to the
				  employee or employee's dependent who submitted the request for
				  review.
(c) A copy of the employing
				  state agency's written decision shall be sent to the employing state agency's
				  administrator or designee and to the public employees benefits board (PEBB)
				  appeals manager. The employing state agency's written decision shall become the
				  employing state agency's final decision effective fifteen days after the date
				  it is rendered.
(d) The employing
				  state agency may reverse eligibility, premium surcharge, or enrollment
				  decisions based only on circumstances that arose due to delays caused by the
				  employing state agency or errors made by the employing state agency.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-16 - Appeals practice and procedure › Part I - GENERAL PROVISIONS › Section 182-16-032 - How can a decision made by the public employees benefits board (PEBB) program regarding eligibility, enrollment, premium payments, premium surcharge, eligibility to participate in the PEBB wellness incentive program or receive a PEBB wellness incentive; or a decision made by an employer group regarding life insurance or LTD insurance be appealed?

Current through Register Vol. 24-14, July 15, 2024
(1) A decision made by the public employees
				  benefits board (PEBB) program regarding eligibility, enrollment, premium
				  payment, premium surcharge, or eligibility to participate in the PEBB wellness
				  incentive program, or eligibility to receive a PEBB wellness incentive, may be
				  appealed by submitting a notice of appeal to the PEBB appeals
				  committee.
(2) A decision made by
				  an employer group regarding life insurance, LTD insurance, eligibility to
				  participate in the PEBB wellness incentive program, or eligibility to receive a
				  PEBB wellness incentive may be appealed by submitting a notice of appeal to the
				  PEBB appeals committee.
(3) The
				  contents of the notice of appeal are to be provided in accordance with WAC
				  182-16-040.
(4) The notice of appeal from a current or
				  former employee or employee's dependent must be received by the PEBB appeals
				  manager no later than thirty days after the date of the denial
				  notice.
(5) The notice of appeal
				  from a retiree, self-pay enrollee, or dependent of a retiree or self-pay
				  enrollee must be received by the PEBB appeals manager no later than sixty days
				  after the date of the denial notice.
(6) The PEBB appeals manager shall notify the
				  appellant in writing when the notice of appeal has been received.
(7) The PEBB appeals committee shall render a
				  written decision to the appellant within thirty days of receiving the notice of
				  appeal. The committee may extend the thirty-day time requirement for rendering
				  a decision upon issuing a written finding of a good reason explaining the cause
				  for the delay.
(8) Any appellant
				  who disagrees with the decisions of the PEBB appeals committee may request an
				  administrative hearing, as described in WAC
				  182-16-050.
Statutory Authority:
						RCW
						41.05.160. 12-20-022 (Order 2012-01), §
												182-16-032, filed 9/25/12,
						effective 11/1/12. Statutory Authority:
						RCW
						41.05.160 and
						2011 c
						8 . 11-22-036 (Order 11-02), §
												182-16-032, filed 10/26/11,
						effective 1/1/12. Statutory Authority:
						RCW
						41.05.160. 10-20-147 (Order 10-02), §
												182-16-032, filed 10/6/10,
						effective 1/1/11; 09-23-102 (Order 09-02), §
												182-16-032, filed 11/17/09,
						effective 1/1/10; 08-20-128 (Order 08-03), §
												182-16-032, filed 10/1/08,
						effective 1/1/09.