Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-08 - Procedures › Section 182-08-180 - Premium payments and premium refunds

Current through Register Vol. 24-14, July 15, 2024
Public employees benefits board (PEBB) insurance coverage
				  premiums and applicable premium surcharges for all subscribers are due as
				  described in this section, except when an employing agency is correcting its
				  enrollment error as described in WAC
				  182-08-187(4)
				  or (5).
(1)
Premium payments.
PEBB
				insurance coverage premiums and applicable premium surcharges for all
				subscribers become due the first of the month in which PEBB insurance coverage
				is effective.
Premiums and applicable premium surcharges are due from the
				  subscriber for the entire month of PEBB insurance coverage and will not be
				  prorated during any month.
(a) For
				subscribers not eligible for the employer contribution that are electing to
				enroll in PEBB retiree insurance coverage as described in WAC
				182-12-171(1)(a),
				182-12-180(3)(a),
				182-12-200(3)(a)
				or (b),
				182-12-205(6)
				or (7),
				182-12-211,
				and
				182-12-265;
				or electing to enroll in continuation coverage as described in WAC
				182-12-133,
				182-12-141,
				182-12-142,
				182-12-146,
				182-12-148,
				and
				182-12-270,
				the first premium payment and applicable premium surcharges are due to the
				health care authority (HCA) or the contracted vendor no later than 45 days
				after the election period ends as described within the Washington
				Administrative Code applicable to the subscriber. 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 long-term
				disability (LTD) insurance coverage. Any medicare part D late enrollment
				penalty associated with the medicare advantage-prescription drug plan must be
				made to the contracted vendor. Premiums associated with life insurance and
				accidental death and dismemberment (AD&D) insurance coverage must be made
				to the contracted vendor. Following the first premium payment, premiums and
				applicable premium surcharges must be paid as premiums become due.
(b) For employees who are eligible for the
				employer contribution, premiums and applicable premium surcharges are due to
				the employing agency or contracted vendor. If an employee elects supplemental
				coverage or employee-paid LTD insurance, or is enrolled in employee-paid LTD
				insurance as described in WAC
				182-08-197(1)(a)
				or (3)(a), or is enrolled in employee-paid
				LTD insurance as described in WAC
				182-08-197(1)(b),
				the employee is responsible for payment of premiums from the month that the
				supplemental coverage or employee-paid LTD insurance begins.
Exception:
An employee who is on a leave of absence and
							 maintains eligibility for the employer contribution, will have their premiums
							 waived for their employee-paid LTD insurance for the first 90 days. For this
							 purpose, "leave of absence" is defined as a paid or unpaid temporary or
							 indefinite administrative leave, involuntary leave, sick leave, or insurance
							 continued under the federal Family and Medical Leave Act, or paid family and
							 medical leave program as described in WAC
							 182-12-138.
(c)
				Unpaid or underpaid premiums or applicable premium surcharges for all
				subscribers must be paid, and are due from the employing agency, subscriber, or
				a subscriber's legal representative to the HCA or contacted vendor. For
				subscribers not eligible for the employer contribution, monthly premiums or
				applicable premium surcharges that remain unpaid for 30 days will be considered
				delinquent. A subscriber is allowed a grace period of 30 days from the date the
				monthly premiums or applicable premium surcharges become delinquent to pay the
				unpaid premium balance or applicable premium surcharges. If a subscriber's
				monthly premiums or applicable premium surcharges remain unpaid for 60 days
				from the original due date, the subscriber's PEBB insurance coverage will be
				terminated retroactive to the last day of the month for which the monthly
				premiums and any applicable premium surcharges were paid. If it is determined
				by the HCA that payment of the unpaid balance in a lump sum would be considered
				a hardship, the HCA may develop a reasonable payment plan of up to 12 months in
				duration with the subscriber or the subscriber's legal representative upon
				request.
Exception:
For a subscriber enrolled in a medicare advantage or
							 a medicare advantage-prescription drug plan a notice will be sent to them
							 notifying them that they are delinquent on their monthly premiums and that the
							 enrollment will be terminated prospectively to the end of the month after the
							 notice is sent.
(d)
				Monthly premiums or applicable premium surcharges due from a subscriber who is
				not eligible for the employer contribution will be considered unpaid if one of
				the following occurs:
(i) No payment of
				premiums or applicable premium surcharges are received by the HCA or contracted
				vendor and the monthly premiums or applicable premium surcharges remain unpaid
				for 30 days; or
(ii) Premium
				payments or applicable premium surcharges received by the HCA or contracted
				vendor are underpaid by an amount greater than an insignificant shortfall and
				the monthly premiums or applicable premium surcharges remain underpaid for 30
				days past the date the monthly premiums or applicable premium surcharges were
				due.