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)?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.
Wash. Admin. Code § 182-12-207
Amended by WSR 16-20-080, Filed 10/4/2016, effective 1/1/2017Amended by WSR 17-19-077, Filed 9/15/2017, effective 1/1/2018Amended by WSR 18-20-117, Filed 10/3/2018, effective 1/1/2019Amended by WSR 19-17-073, Filed 8/20/2019, effective 1/1/2020Amended by WSR 20-16-062, Filed 7/28/2020, effective 1/1/2021Statutory Authority: RCW 41.05.160. 09-23-102 (Order 09-02), §182-12-207, filed 11/17/09, effective 1/1/10; 07-20-129 (Order 07-01), §182-12-207, filed 10/3/07, effective 11/3/07.