Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-133 - What options for continuation coverage are available to employees and their dependents during certain types of leave or when employment ends due to a layoff?

Current through Register Vol. 24-14, July 15, 2024
Employees who have established eligibility for public
				  employees benefits board (PEBB) benefits as described in WAC
				  182-12-114
				  may continue coverage for themselves and their dependents during certain types
				  of leave or when their employment ends due to a layoff.
(1) Employees who are no longer eligible for
				the employer contribution toward PEBB benefits due to an event described in
				(b)(i) through (vi) of this subsection may continue coverage by self-paying the
				premium and applicable premium surcharges set by the health care authority
				(HCA) from the date eligibility for the employer contribution is lost:
(a) Employees may continue any combination of
				medical or dental, and may also continue life insurance and accidental death
				and dismemberment (AD&D) insurance. 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. Employees on approved
				educational leave or called in to active duty in the uniformed services as
				defined under the Uniformed Services Employment and Reemployment Rights Act
				(USERRA) may continue either employer-paid long-term disability (LTD) insurance
				or both employer-paid and employee-paid LTD insurance.
(b) Employees in the following circumstances
				who lose their eligibility for the employer contribution toward PEBB benefits
				qualify to continue coverage under this subsection:
(i) Employees who are on authorized leave
				without pay;
(ii) Employees who are
				on approved educational leave;
(iii) Employees who are receiving time-loss
				benefits under workers' compensation;
(iv) Employees who are called to active duty
				in the uniformed services as defined under USERRA;
(v) Employees whose employment ends due to a
				layoff as defined in WAC
				182-12-109;
				and
(vi) Employees who are applying
				for disability retirement.
(c) 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;
(d) Employees may self-pay for a maximum of
				twenty-nine months. The employee's first premium payment and applicable premium
				surcharges are due no later than forty-five days after the election period ends
				as described in (c) 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 or LTD insurance coverage. Premiums associated with
				  continuing life insurance and AD&D insurance coverage must be made to the
				  contracted vendor. Following the employee's first premium payment, the employee
				  must pay the premium amounts for PEBB insurance coverage and applicable premium
				  surcharges as premiums become due; and
(e) 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).