Section 182-12-260 - Who are eligible dependents?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.Wash. Admin. Code § 182-12-260
Amended by WSR 14-20-058, Filed 9/25/2014, effective 1/1/2015Amended by WSR 15-22-099, Filed 11/4/2015, effective 1/1/2016Amended 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 and 2012 2nd sp.s. c 3 . WSR 13-22-019 (Admin. 2013-01), §182-12-260, filed 10/28/13, effective 1/1/14. Statutory Authority: RCW 41.05.160. WSR 12-20-022 (Order 2012-01), §182-12-260, filed 9/25/12, effective 11/1/12. Statutory Authority: RCW 41.05.160 and 2011 c 8 . WSR 11-22-036 (Order 11-02), §182-12-260, filed 10/26/11, effective 1/1/12. Statutory Authority: RCW 41.05.160. WSR 10-20-147 (Order 10-02), §182-12-260, filed 10/6/10, effective 1/1/11; WSR 09-23-102 (Order 09-02), §182-12-260, filed 11/17/09, effective 1/1/10; WSR 08-20-128 (Order 08-03), §182-12-260, filed 10/1/08, effective 1/1/09; WSR 07-20-129 (Order 07-01), §182-12-260, filed 10/3/07, effective 11/3/07. Statutory Authority: RCW 41.05.160, 41.05.350, and 41.05.165. WSR 05-16-046 (Order 05-01), §182-12-260, filed 7/27/05, effective 8/27/05. Statutory Authority: RCW 41.05.160 and 41.05.165. WSR 04-18-039, §182-12-260, filed 8/26/04, effective 1/1/05. WSR 13-21-033, §182-12-260, filed 10/9/2013, effective 11/9/2013