Wash. Admin. Code § 182-12-270

Current through Register Vol. 24-23, December 1, 2024

Section 182-12-270 - [Effective 1/1/2025] What options for continuation coverage are available to dependents who cease to meet the eligibility criteria as described in WAC 182-12-260?

If eligible, dependents may continue health plan enrollment under one of the continuation coverage options in subsection (1) or (2) of this section by self-paying the premiums and applicable premium surcharges set by the health care authority (HCA), with no contribution from the employer, following their loss of eligibility under the subscriber's health plan coverage. The dependent's first premium payment and applicable premium surcharges are due no later than 45 days after the election period ends as described in WAC 182-12-146, 182-12-180, 182-12-250, or 182-12-265, whichever applies, except as described in WAC 182-08-180 (1)(a). 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 and PEBB vision insurance coverages. Following the dependent's first premium payment, the dependent must pay premium and applicable premium surcharges as they become due. If the monthly premium or applicable premium surcharges remain unpaid for 60 days from the original due date, PEBB insurance coverage will be terminated retroactive to the last day of the month for which the monthly premium and applicable premium surcharges were paid as described in WAC 182-08-180 (1)(c). The PEBB program must receive the required forms as outlined in the PEBB Initial Notice of COBRA and Continuation Coverage Rights. Options for continuing health plan enrollment are based on the reason that eligibility was lost.

(1) Spouses, state registered domestic partners, or children who lose eligibility due to the death of an employee or retiree may be eligible to continue health plan enrollment as described in WAC 182-12-180, 182-12-250, or 182-12-265; or

(2) Dependents who lose eligibility because they no longer meet the eligibility criteria as described in WAC 182-12-260 are eligible to continue PEBB medical, dental, vision, or any combination of these coverages under provisions of the federal Consolidated Omnibus Budget Reconciliation Act (COBRA). See WAC 182-12-146 for more information on COBRA.

(3) A subscriber's state registered domestic partner and the state registered domestic partner's children may continue PEBB medical, dental, vision, or any combination of these coverages on the same terms and conditions as spouses and other eligible dependents under COBRA as described under RCW 26.60.015.

(4) No continuation coverage will be offered unless the PEBB program is notified through hand-delivery or United States Postal Service mail of the qualifying event as outlined in the PEBB Initial Notice of COBRA and Continuation Coverage Rights.

Wash. Admin. Code § 182-12-270

Amended by WSR 14-20-058, Filed 9/25/2014, effective 1/1/2015

Amended by WSR 16-20-080, Filed 10/4/2016, effective 1/1/2017

Amended by WSR 17-19-077, Filed 9/15/2017, effective 1/1/2018

Amended by WSR 18-20-117, Filed 10/3/2018, effective 1/1/2019

Amended by WSR 19-17-073, Filed 8/20/2019, effective 1/1/2020

Amended by WSR 20-16-062, Filed 7/28/2020, effective 1/1/2021

Amended by WSR 24-18-076, Filed 8/29/2024, effective 1/1/2025

Statutory Authority: RCW 41.05.160. 12-20-022 (Order 2012-01), §182-12-270, filed 9/25/12, effective 11/1/12; 09-23-102 (Order 09-02), §182-12-270, filed 11/17/09, effective 1/1/10; 08-20-128 (Order 08-03), §182-12-270, filed 10/1/08, effective 1/1/09; 07-20-129 (Order 07-01), §182-12-270, filed 10/3/07, effective 11/3/07. Statutory Authority: RCW 41.05.160, 41.05.350, and 41.05.165. 05-16-046 (Order 05-01), §182-12-270, filed 7/27/05, effective 8/27/05. Statutory Authority: RCW 41.05.160 and 41.05.165. 04-18-039, §182-12-270, filed 8/26/04, effective 1/1/05.