Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-08 - Procedures › Section 182-08-198 - When may a subscriber change health plans?

Current through Register Vol. 24-14, July 15, 2024
A subscriber may change health plans at the following
				  times:
(1)
During the annual
				open enrollment:
A subscriber may change health plans during the public
				employees benefits board (PEBB) annual open enrollment period. A subscriber
				must submit the required enrollment forms to change their health plan. An
				employee submits the enrollment forms to their employing agency. Any other
				subscriber submits the enrollment forms to the PEBB program. The required
				enrollment forms must be received no later than the last day of the annual open
				enrollment. Enrollment in the new health plan will begin January 1st of the
				following year.
(2)
During a
				special open enrollment:
A subscriber may revoke their health plan
				election and make a new election outside of the annual open enrollment if a
				special open enrollment event occurs. A special open enrollment event must be
				an event other than an employee gaining initial eligibility for PEBB benefits
				as described in WAC
				182-12-114 or regaining
				eligibility for PEBB benefits as described in WAC
				182-08-197. The change in
				enrollment must be allowable under Internal Revenue Code and Treasury
				regulations, and correspond to and be consistent with the event that creates
				the special open enrollment for the subscriber, the subscriber's dependent, or
				both.
A subscriber may not change their health plan during a
				  special open enrollment if their state registered domestic partner or state
				  registered domestic partner's child is not a tax dependent. A subscriber may
				  change their health plan as described in subsection (1) of this section.
To disenroll from a medicare advantage (MA) plan or medicare
				  advantage-prescription drug (MA-PD) plan, the change in enrollment must be
				  allowable under 42 C.F.R.
				  Secs. 422.62(b) and
				  423.38(c). To
				  make a health plan change, a subscriber must submit the required enrollment
				  forms (and a completed disenrollment form, if required). The forms must be
				  received no later than 60 days after the event occurs, except as described in
				  (i) of this subsection. An employee submits the enrollment forms to their
				  employing agency. Any other subscriber submits the enrollment forms to the PEBB
				  program. In addition to the required forms, a subscriber must provide evidence
				  of the event that created the special open enrollment. New health plan coverage
				  will begin the first day of the month following the later of the event date or
				  the date the form is received. If that day is the first of the month, the
				  change in enrollment begins on that day except for a MA or MA-PD plan which
				  will begin the first day of the month following the date the form is
				  received.
Exception:
When a subscriber or their dependent is enrolled in a
							 MA or MA-PD plan, they may disenroll during a special enrollment period as
							 allowed under 42 C.F.R.
							 Secs. 422.62(b) and
							 423.38(c). The
							 new medical plan coverage will begin the first day of the month following the
							 date the medicare advantage plan disenrollment form is received.
If the special open enrollment is due to the birth, adoption,
				  or assumption of legal obligation for total or partial support in anticipation
				  of adoption of a child, health plan coverage will begin the month in which the
				  birth, adoption, or assumption of legal obligation for total or partial support
				  in anticipation of adoption occurs. If the special open enrollment is due to
				  the enrollment of an extended dependent or a dependent with a disability, the
				  change in health plan coverage will begin the first day of the month following
				  the later of the event date or eligibility certification. 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 state
				registered domestic partnership;
(ii) Birth, adoption, or when the subscriber
				has assumed a legal obligation for total or partial support in anticipation of
				adoption; or
(iii) A child becoming
				eligible as an extended dependent through legal custody or legal
				guardianship.