Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-12 - Eligible and noneligible employees › Section 182-12-260 - Who are eligible dependents?

Current through Register Vol. 24-14, July 15, 2024
To be enrolled in PEBB health plan coverage, a dependent must
				  be eligible under this section and the subscriber must comply with enrollment
				  procedures outlined in WAC
				  182-12-262.
The public employees benefits board (PEBB) program verifies
				  the eligibility of all dependents and will request documents from subscribers
				  that provide evidence of a dependent's eligibility. The PEBB program reserves
				  the right to review a dependent's eligibility at any time. The PEBB program
				  will remove a subscriber's enrolled dependents from health plan coverage if the
				  PEBB program is unable to verify a dependent's eligibility. A dependent will
				  not be enrolled in PEBB health plan coverage if the PEBB program or the
				  employing agency is unable to verify the dependent's eligibility within the
				  PEBB program enrollment timelines.
The subscriber must provide notice, in writing, when their
				  dependent is not eligible under this section as described in WAC
				  182-12-262(2)(a).
The following are eligible as dependents:
(1) Legal spouse. A former spouse is not an
				eligible dependent upon finalization of a divorce or annulment, even if a court
				order requires the subscriber to provide health insurance for the former
				spouse;
(2) State registered
				domestic partner. A former state registered domestic partner is not an eligible
				dependent upon dissolution or termination of a partnership, even if a court
				order requires the subscriber to provide health insurance for the former
				partner;
(3) Children. Children are
				eligible through the last day of the month in which their twenty-sixth birthday
				occurred except as described in (g) of this subsection. Children are defined as
				the subscriber's:
(a) Children based on
				establishment of a parent-child relationship as described in
				RCW
				26.26A.100, except when parental rights have
				been terminated;
(b) Children of
				the subscriber's spouse, based on the spouse's establishment of a parent-child
				relationship, except when parental rights have been terminated. The stepchild's
				relationship to the subscriber (and eligibility as a dependent) ends on the
				same date the marriage with the spouse ends through divorce, annulment,
				dissolution, termination, or death;
(c) Children for whom the subscriber has
				assumed a legal obligation for total or partial support in anticipation of
				adoption of the child;
(d) Children
				of the subscriber's state registered domestic partner, based on the state
				registered domestic partner's establishment of a parent-child relationship,
				except when parental rights have been terminated. The child's relationship to
				the subscriber (and eligibility as a dependent) ends on the same date the
				subscriber's legal relationship with the state registered domestic partner ends
				through divorce, annulment, dissolution, termination, or death;
(e) Children specified in a court order or
				divorce decree for whom the subscriber has a legal obligation to provide
				support or health care coverage;
(f) Extended dependent in the legal custody
				or legal guardianship of the subscriber, the subscriber's spouse, or
				subscriber's state registered domestic partner. The legal responsibility is
				demonstrated by a valid court order and the child's official residence with the
				custodian or guardian. Extended dependent child does not include a foster child
				unless the subscriber, the subscriber's spouse, or the subscriber's state
				registered domestic partner has assumed a legal obligation for total or partial
				support in anticipation of adoption; and
(g) Children of any age with a developmental
				or physical disability that renders the child incapable of self-sustaining
				employment and chiefly dependent upon the subscriber for support and
				maintenance provided such condition occurs before the age of twenty-six:
(i) The subscriber must provide proof of the
				disability and dependency within sixty days of the child's attainment of age
				twenty-six;
(ii) The subscriber
				must notify the PEBB program, in writing, when the child is no longer eligible
				under this subsection as described in WAC
				182-12-262(2)(a);
(iii) A child with a developmental or
				physical disability who becomes self-supporting is not eligible under this
				subsection as of the last day of the month in which they become capable of
				self-support;
(iv) A child with a
				developmental or physical disability age twenty-six and older who becomes
				capable of self-support does not regain eligibility if they later become
				incapable of self-support; and
(v)
				The PEBB program with input from the applicable contracted vendor will
				periodically verify the eligibility of a dependent child with a disability
				beginning at age twenty-six, but no more frequently than annually after the
				two-year period following the child's twenty-sixth birthday. Verification will
				require renewed proof of disability and dependence from the
				subscriber.