WSR 06-16-107

EXPEDITED RULES

HEALTH CARE AUTHORITY


(Public Employees' Benefits Board)

[ Order 06-08 -- Filed August 1, 2006, 11:14 a.m. ]

Title of Rule and Other Identifying Information: WAC 182-12-250 Insurance eligibility for surviving dependents of emergency service personnel killed in the line of duty.

NOTICE

THIS RULE IS BEING PROPOSED UNDER AN EXPEDITED RULE-MAKING PROCESS THAT WILL ELIMINATE THE NEED FOR THE AGENCY TO HOLD PUBLIC HEARINGS, PREPARE A SMALL BUSINESS ECONOMIC IMPACT STATEMENT, OR PROVIDE RESPONSES TO THE CRITERIA FOR A SIGNIFICANT LEGISLATIVE RULE. IF YOU OBJECT TO THIS USE OF THE EXPEDITED RULE-MAKING PROCESS, YOU MUST EXPRESS YOUR OBJECTIONS IN WRITING AND THEY MUST BE SENT TO Barbara Scott, Health Care Authority, P.O. Box 42684, Olympia, WA 98504-2684, bsco107@hca.wa.gov , AND RECEIVED BY October 2, 2006.


Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of amending the existing rule is to implement provisions of chapter 345, Laws of 2006, which changed the eligibility criteria for surviving dependents of emergency service personnel killed in the line of duty to include survivors of emergency service employees who were killed in the line of duty prior to January 1, 1998.

Reasons Supporting Proposal: These amendments will implement provisions enacted by the 2006 legislature.

Statutory Authority for Adoption: RCW 41.05.160.

Statute Being Implemented: RCW 41.05.080.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Health care authority, governmental.

Name of Agency Personnel Responsible for Drafting: Barbara Scott, Health Care Authority, (360) 923-2642; Implementation and Enforcement: Mary Fliss, Health Care Authority, (360) 923-2640.

August 1, 2006

Beth Dupre

Deputy Administrator

OTS-9046.2


AMENDATORY SECTION(Amending WSR 04-18-039, filed 8/26/04, effective 1/1/05)

WAC 182-12-250   Insurance eligibility for surviving dependents of emergency service personnel killed in the line of duty.   Surviving dependents of emergency service personnel who ((were)) are killed in the line of duty ((on or after January 1, 1998,)) are eligible ((to participate in)) for health plan coverage administered by the HCA.

(1) This section applies to the dependents of emergency service personnel "killed in the line of duty" as determined ((consistent with Title 51 RCW)) by the Washington state department of labor and industries.

(2) "Emergency service personnel" means law enforcement officers((,)) and fire fighters as defined in RCW 41.26.030, and reserve officers((,)) and fire fighters as defined in RCW ((41.26.030 and)) 41.24.010.

(3) "Surviving dependent" means:

(a) A lawful spouse ((or));

(b) An ex-spouse as defined in RCW 41.26.162; ((and

(b))) (c) Dependent children. The term "children" includes the following unmarried ((natural children, stepchildren and legally adopted)) children of the emergency service worker who are: Under the age of twenty or under the age of twenty-four ((for)) if he or she is a dependent student attending high school or registered at an accredited secondary school, college, university, vocational school, or school of nursing. Disabled dependents as defined in RCW 41.26.030(7) are eligible at any age. "Children" are defined as:

(i) Biological children (including the emergency service worker's posthumous children);

(ii) Stepchildren; and

(iii) Legally adopted children.

(4) ((Premium rates will be subsidized consistent with rates established by PEBB for non-Medicare retirees under RCW 41.05.022 and for Medicare-entitled retirees under RCW 41.05.085.

(5))) Surviving dependents ((that)) who are entitled to Medicare((-entitled)) must enroll in both parts A and B of Medicare.

(((6))) (5) The surviving dependent must send a completed enrollment ((application)) form (to either enroll or defer public employees' benefits board (PEBB) coverage) to PEBB benefits services department no later than ((sixty)) one hundred eighty days after the latter of:

(a) The death of the emergency service worker;

(b) The date on the letter from the department of retirement systems or the board for volunteer fire fighters and reserve officers that informs the survivor that he or she is determined to be an eligible survivor;

(c) The last day ((of)) the surviving dependent was covered under any ((coverage extended by the employing agency of)) health plan through the emergency service ((employee who died in the line of duty)) worker's employer; or

(((b))) (d) The last day ((of coverage extended through)) the surviving dependent was covered under the Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage from ((any employing agency)) the emergency service worker's employer.

(6) Survivors that do not choose to defer PEBB coverage may choose among the following options for when their PEBB coverage will begin:

(a) June 1, 2006, for survivors whose enrollment form is received by PEBB benefit services no later than September 1, 2006;

(b) The first of the month that is no more than sixty days before the date that PEBB benefit services receives the enrollment form (for example, if PEBB benefit services receives the enrollment form on August 29, the survivor may request coverage to begin on July 1); or

(c) The first of the month after the date that PEBB benefit services receives the enrollment form.

For surviving dependents who enroll, monthly premiums for PEBB health plan coverage must be paid by the survivor except as provided in RCW 41.26.510(5).

(7) Surviving dependents must choose one of the following two options ((for maintaining)) to maintain eligibility for ((participation under)) PEBB health plan coverage:

(a) Enroll in PEBB health plan coverage:

(i) ((Enrollment)) Enroll in ((the)) medical ((portion of PEBB health plan)) coverage ((is required.)); or

(ii) ((Enrollment in the dental portion of PEBB health plan coverage is optional. Once enrolled in)) Enroll in medical and dental coverage.

(iii) The ((person)) dependent must ((maintain enrollment)) stay enrolled in dental coverage for ((a minimum of)) at least two years before dental coverage can be dropped.

(((iii))) (iv) Dental only coverage is not ((available)) an option.

(b) Defer enrollment:

(i) Surviving dependents may defer enrollment in PEBB health plan coverage if they are enrolled in ((employer sponsored)) comprehensive medical coverage through ((their employment)) an employer.

(ii) Surviving dependents may enroll in PEBB health plan coverage when ((their)) they lose employer ((sponsored)) coverage ((ends)). ((Proof of continuous enrollment)) Dependents will need to prove they were continuously enrolled in ((other)) comprehensive ((employer sponsored)) coverage ((must be submitted with the application)) through an employer when applying for ((enrollment to the HCA)) PEBB coverage, and apply within sixty days after the date ((that)) their other coverage ended.

(iii) PEBB health plan coverage and premiums will begin the first day of the month following the day that the other coverage ended for dependents that reenroll.

(8) ((Enrollees)) Surviving dependents may change their health ((carrier selection)) plan during open enrollment. In addition to open enrollment, ((enrollees)) they may change health ((carriers)) plans if they move out of their health ((carrier's)) plan's service area or into a service area where a health ((carrier)) plan that was not previously offered is now available.

(9) Surviving dependents may not add new dependents acquired through birth, marriage, or establishment of a qualified same-sex domestic partnership.

(10) Surviving dependents will ((forfeit)) lose their right to enroll in PEBB health plan coverage if they:

(a) Do not ((make application)) apply to enroll or defer PEBB ((before)) health plan coverage within the ((date specified)) timelines stated in subsection (((6))) (5) of this section; or

(b) Do not maintain continuous enrollment in comprehensive coverage through an employer ((sponsored medical coverage)) during the deferral period, as provided in subsection (7)(b)(i) of this section.

[Statutory Authority: RCW 41.05.160 and 41.05.165. 04-18-039, 182-12-250, filed 8/26/04, effective 1/1/05.]

Washington State Code Reviser's Office