WSR 11-22-069

INTERPRETIVE AND POLICY STATEMENT

HEALTH CARE AUTHORITY


(Public Employees Benefits Board)

[ Filed October 31, 2011, 5:04 p.m. ]


Notice of Interpretive or Policy Statements


The following is a list of policy and interpretive statements issued by the public employee[s] benefits board (PEBB) program regarding employee eligibility and enrollment. The complete policy statements can be downloaded on-line from http://www.pebb.hca.wa.gov/policy.html.

Policy #26-1: Administering PEBB insurance in coordination with Medicare Part D. The purpose of this policy is to administer PEBB retiree medical plan enrollment in order to participate in the employer incentive program established in Section 1860D-22 of the Medicare Prescription Drug Improvement and Modernization Act of 2003.

Policy #36-1: Certifying eligibility for dependent children with disabilities who are age 26 and older. The purpose of this policy is to clarify criteria used by the PEBB program to certify the eligibility of a dependent child with a disability who is age twenty-six and older.

Policy #37-1: Certifying eligibility for extended dependents. The purpose of this policy is to clarify the criteria used by the PEBB program to certify the eligibility of an extended dependent.

The PEBB program is rescinding the following policies and procedures:

Policy #2-01: Records Retention. The purpose of this policy was to provide guidelines for the PEBB program for record retention of documents. This information is procedural.

Policy #2-02: Pager. The purpose of this policy was to establish guidelines for health insurance benefits specialists in using the pager in support of lobby customer service. These guidelines are now posted on the PEB[B] intranet for staff use.

Policy #2-03: Phone Coverage. The purpose of this policy was to establish service level expectations and describe the method through which phone coverage would be managed. This information is managed via the use of call forecasting and scheduling software.

Policy #2-04: Destruction of Personal/Confidential Information. The purpose of this policy was to provide the PEBB program with guidelines when disposing of personal/confidential documents. This information is procedural.

Policy #2-05: Open Enrollment Procedures. The purpose of this policy was to outline the procedural responsibilities of the PEBB outreach and training unit in support of the annual open enrollment period. This information is procedural.

Policy #2-06: PEBB Agency Training & Outreach Activities. The purpose of this policy was to identify the PEBB outreach and training unit responsibilities. This information is procedural.

Policy #2-07: Returned mail processing. The purpose of this policy was to provide guidelines to PEBB staff for processing returned mail. This information is procedural.

Policy #2-08: Administration of an Address Change for a Subscriber. The purpose of this policy is to provide the PEBB staff with guidelines for processing a change of address request. This information is procedural.

Policy #2-09: Mailing of Open Enrollment Packets after Oct 1 (Late Notification). The purpose of this policy was to provide guidelines for the PEBB program when mailing open enrollment packets to self-pay and retirees after the initial open enrollment mailing. This information is procedural.

Task 2-10: Automated Letter Generation - Packet Request Form. The purpose of this task was to provide steps for PEBB program staff to take to process a Packet Request Form. This information is a task.

Policy #3-01: Management of enrollment in PEBB retiree insurance coverage for members enrolling in a Medicare Part D Plan. The purpose of this policy was to provide PEBB retiree insurance coverage to members enrolled in Medicare Parts A, B, and D that is compliant with federal and state laws. This information is superseded by proposed Policy #26-1 (Administering PEBB insurance in coordination with Medicare Part D).

Policy #3-02: Medicare Part D: PEBB retiree and employee coverage for members not eligible for enrollment in a Medicare Supplement who pay the non-Medicare medical plan rate and not receiving the prescription drug subsidy. The purpose of this policy was to provide PEBB-sponsored medical coverage to members who enroll in Medicare Part D but who are not eligible for enrollment in a PEBB-sponsored medicare supplement plan that is compliant with federal and state laws. This information is superseded by proposed Policy #26-1 (Administering PEBB insurance in coordination with Medicare Part D).

Policy #3-03: Medicare Part D: PEBB retiree and employee coverage for dependent children enrolled in Medicare Part D. The purpose of this policy was to provide PEBB-sponsored medical coverage to dependent children enrolled in Medicare Parts A, B, and D that is compliant with federal and state laws. This information is superseded by proposed Policy #26-1 (Administering PEBB insurance in coordination with Medicare Part D).

Policy #4-02: Certification of Dependents with Disabilities. The purpose of this policy was to establish guidelines for processing a PEBB subscriber's request to certify an overage dependent as a disabled dependent. This information is superseded by proposed Policy #36-1: Certifying eligibility for dependent children with disabilities who are over age 26.

Policy #4-03: Certification and Re-Certification of Extended Dependent Children enrolled in PEBB Medical, Dental or Life Insurance Plan. The purpose of this policy was to establish guidelines for initial or continued enrollment of a child under eligibility criteria for extended dependent children. This information is superseded by proposed Policy #37-1: Certifying eligibility for extended dependents.

Policy #4-03: Request for Addition of Extended Dependent to PEBB Medical, Dental or Life Insurance Plans. The purpose of this policy was to clarify the eligibility criteria required for an extended dependent to qualify for or retain coverage under the PEBB program. This information is superseded by proposed Policy #37-1: Certifying eligibility for extended dependents.

Policy #4-03: Alternative Identification Number. The purpose of this policy was to define guidelines for the PEBB program when a PEBB uniform dental plan enrollee requests an alternative identification number. This information is procedural.

Policy #4-04: Verification of Enrollment in the PEBB Benefits Services Program. The purpose of this policy was to provide guidelines to the PEBB program when there is a request for enrollment verification. This information is procedural.

Policy #4-04: Request for Addition of Extended Dependent to PEBB Medical, Dental or Life Insurance Plans. The purpose of this policy was to clarify the eligibility criteria required for an extended dependent to qualify for or retain coverage under the PEBB program. This information is superseded by proposed policy #37-1 (Certifying Extended Dependents).

Policy #4-05: Working Monthly Dual Coverage Report. The purpose of this policy was to establish an interim process for the administration of WAC 182-12-123 until functionality is available in the new insurance system. This information is procedural.

Policy #4-05: Verification of Enrollment in the PEBB Benefits Services Program. The purpose of this policy was to provide guidelines to the PEBB program when there is a request for enrollment verification. This information is procedural.

Policy #4-06: Working Monthly Dual Coverage Report. The purpose of this policy was to establish an interim process for the administration of WAC 182-12-123 until functionality is available in the new insurance system. This information is procedural.

Policy #4-07: Request for Change of PEBB Medical or Dental Plans. The purpose of this policy was to establish guidelines for the PEBB program when an employee, self-pay, COBRA or retiree subscriber requests to change his/her medical or dental plans outside an open enrollment period. This is now addressed in rule.

Policy #4-10: Enrollment in the PEBB program following post-retirement employment. The purpose of this policy was to clarify the application of the provisions of chapter 182-12 WAC as they relate to employees that apply for participation in PEBB retiree insurance following post-retirement employment with a PEBB employer or Washington state K-12 school district or educational service district (ESD). The PEBB program will address this in a future policy.

Policy #410: Alternative Identification Number. The purpose of this policy was to define guidelines for the PEBB program when a PEBB uniform dental plan enrollee requests an alternative identification number. This information is procedural.

Procedure #411: Procedures for processing retroactive eligibility changes. The purpose of this procedure was to outline the procedure for PEB[B] and accounting staff for processing retroactive eligibility changes. This information is now addressed in guidance.

Procedure #4-11: Procedures for processing retroactive eligibility changes. The purpose of this procedure is to outline the procedure for PEBB and accounting staff for processing retroactive eligibility changes. This information is now addressed in guidance.

Task #412: Producing a Statement of Insurance Upon Request. The purpose of this task was to lists [list] the steps a benefits specialist takes to produce a manual statement of insurance. This information is a task.

Task #413: Processing Requests to Defer PEBB Coverage Upon Retirement. The purpose of this task was to lists [list] the steps a benefits specialist takes to process a request to defer PEBB coverage. This information is a task.

Task #4-13: Processing Requests to Defer PEBB Coverage Upon Retirement. The purpose of this task was to lists [list] the steps a benefits specialist takes to process a request to defer PEBB coverage. This information is a task.

Policy #6-01: Retroactive Termination Policy. The purpose of this policy is to establish an agency policy on retroactive premium refunds related to termination of member eligibility for all PEBB plans. This information is now addressed in guidance.

Policy #7-02: Waiver of Medical Coverage (for employer groups paying a composite rate). The purpose of this policy was to provide the PEBB program with guidelines if an employer group has an employee who wants to waive his/her medical coverage. This information is addressed in WAC 182-08-190(4).

Policy #7-02: Employer Group with Past Due Accounts. The purpose of this policy was to provide guidelines to the PEBB program and HCA accounts receivable when an employer group has a delinquent account balance. This information is addressed in WAC 182-08-190(6).

Policy #7-03: Waiver of Medical Coverage (for employer groups paying a composite rate). The purpose of this policy was to provide the PEBB program with guidelines if an employer group has an employee who wants to waive his/her medical coverage. This information is addressed in WAC 182-08-190(4).

Policy #7-03: Application requirements for employer groups. The purpose of this policy is to outline the application requirements for employer groups who want to participate in PEBB insurance and to effectuate RCW 41.04.205. This information is now posted on the PEBB web site.

Policy #7-04: Application requirements for employer groups. The purpose of this policy is to outline the application requirements for employer groups who want to participate in PEBB insurance and to effectuate RCW 41.04.205. This information is now posted on the PEBB web site.

Policy #7-04: Employer Group Participation Requirements. The purpose of this policy was to outline the PEBB program participation and eligibility requirements for employer groups. This information is addressed in WAC 182-12-111, 182-12-114, and 182-12-260.

Policy #7-05: Eligibility requirements for employer group participation in the PEBB Program. The purpose of this policy was to outline the PEBB program participation and eligibility requirements for employer groups. This information is addressed in WAC 182-12-111, 182-12-114, and 182-12-260.

Policy #7-05: Employer Group Participation Requirements. The purpose of this policy was to outline the PEBB program participation and eligibility requirements for employer groups. This information is addressed in WAC 182-12-111, 182-12-114, and 182-12-260.

Policy #7-06: Eligibility requirements for employer group participation in the PEBB Program. The purpose of this policy was to outline the PEBB program participation and eligibility requirements for employer groups. This information is addressed in WAC 182-12-111, 182-12-114, and 182-12-260.

Policy #8-01: Application requirements for School Districts and Educational Service Districts. The purpose of this policy was to outline the application requirements for school districts and educational service districts who want to participate in PEBB insurance and to effectuate RCW 41.04.205. This information is now posted on the PEBB web site.

Policy #8-01: Administration of an accelerated life benefit. The purpose of this policy was to clarify the roles of the agency, carrier, and PEBB program in the administration of an accelerated life benefit. This information is procedural.

Policy #8-02: Participation requirements for School Districts or Educational Service Districts. The purpose of this policy is to define requirements for a school district and educational service district to participate in PEBB insurance and to effectuate RCW 41.04.205. This information is procedural.

Policy #8-02: Administration of Waiver of Life Insurance Premium Claim. The purpose of this policy was to clarify the roles of the agency, carrier, and PEBB program in the administration of the waiver of life insurance premium claim. This information is procedural.

Policy #8-03: Policy and Procedures for Processing a School District or Educational Service District Application. The purpose of this policy was to define procedures for processing school districts' or educational service districts' applications for participation in PEBB insurance and to effectuate RCW 41.04.205. This information is procedural.

Policy #8-03: Policy and Procedures for processing a School District or Educational Service District Application. The purpose of this policy was to define procedures for processing school districts' or educational service districts' applications for participation in the PEBB insurance programs, and to effectuate RCW 41.04.205. This information is procedural.

Policy #8-03: Employee/Dependent Life Insurance Death Claim Administration. The purpose of this policy was to clarify the roles of the agency, carrier, and PEBB program in the administration of an employee and dependent life insurance death claim. This information is procedural.

Policy #8-04: Administration of Employee Life Insurance Enrollment. The purpose of this policy was to clarify the roles of the agency, carrier and the PEBB program in the administration of enrollment in the term life, accidental death and dismemberment insurance programs. This information is procedural.

Policy #8-05: Administration of Accidental Death and Dismemberment Claims. The purpose of this policy was to clarify the roles of an agency, carrier and the PEBB program in the administration of an accidental death and dismemberment claim. This information is procedural.

Policy #8-06: Administration and Maintenance of the Request for Change of Beneficiary (7384n-1). The purpose of this policy was to clarify the roles of the agency, carrier, and PEBB program in the administration and maintenance of the request for change of beneficiary form. This information is procedural.

Policy #8-07: Administration of Long Term Disability (LTD) Claims. The purpose of this policy was to clarify the roles of the agency, carrier, and PEBB program in the administration of the long-term disability claims and benefits. This information is procedural.

Policy #8-08: Administration of Optional Long Term Disability Enrollment. The purpose of this policy was to clarify the roles of the agency, carrier, and PEBB program in the administration of enrollment in the optional long-term disability insurance program. This information is procedural.

Policy #8-09: Nonsmoker Refund Requests. The purpose of this policy was to clarify the amount of time for which PEBB staff is authorized to refund the difference between the smoker and nonsmoker premium rate for optional life insurance. This information is now addressed in guidance.

Policy #9-01: Administration of an accelerated life benefit. The purpose of this policy was to clarify the roles of the agency, carrier, and PEBB program in the administration of an accelerated life benefit. This information is procedural.

Policy #9-02: Administration of Waiver of Life Insurance Premium Claim. The purpose of this policy was to clarify the roles of the agency, carrier, and PEBB program in the administration of the waiver of life insurance premium claim. This information is procedural.

Policy #9-03: Employee/Dependent Life Insurance Death Claim Administration. The purpose of this policy was to clarify the roles of the agency, carrier, and PEBB program in the administration of an employee and dependent life insurance death claim. This information is procedural.

Policy #9-04: Administration of Employee Life Insurance Enrollment. The purpose of this policy was to clarify the roles of the agency, carrier, and PEBB program in the administration of enrollment in the term life, accidental death and dismemberment insurance programs. This information is procedural.

Policy #9-05: Administration of Accidental Death and Dismemberment Claims. The purpose of this policy was to clarify the roles of the agency, carrier, and PEBB program in the administration of an accidental death and dismemberment claim. This information is procedural.

Policy #9-06: Administration and Maintenance of the Request for Change of Beneficiary (7384n-1). The purpose of this policy was to clarify the roles of the agency, carrier, and PEBB program in the administration and maintenance of the request for change of beneficiary form. This information is procedural.

Policy #9-07: Administration of Long Term Disability (LTD) Claims. The purpose of this policy was to clarify the roles of the agency, carrier, and PEBB program in the administration of the long-term disability claims and benefits. This information is procedural.

Policy #9-08: Administration of Optional Long Term Disability Enrollment. The purpose of this policy was to clarify the roles of the agency, carrier and the PEBB program in the administration of enrollment in the optional long-term disability insurance program. This information is procedural.

Policy #9-09: Nonsmoker Refund Requests. The purpose of this policy was to clarify the amount of time for which PEBB staff is authorized to refund the difference between the smoker and nonsmoker premium rate for optional life insurance. This information is now addressed in guidance.

Policy #7-04K-12: Application Requirements for School Districts and Educational Service Districts. The purpose of this policy was to outline the application requirements for school districts and educational service districts who want to participate in PEBB insurance and to effectuate RCW 41.04.205. This information is now posted on the PEBB web site.

Policy #7-05K-12: Participation Requirements for School Districts and Educational Service Districts. The purpose of this policy was to define requirements for a school district and educational service district to participate in PEBB insurance and to effectuate RCW 41.04.205. This information is now posted on the PEBB web site.

Policy #45-1: PEBB Child-up-to-Age-26 Automatic Eligibility Conversion and January 1, 2011 Special Open Enrollment. The purpose of this policy was to transition enrolled children from enrollment under eligibility criteria which were eliminated January 1, 2011, to national health care reform mandated eligibility criteria which requires coverage of children up to age twenty-six. This policy is no longer necessary, as the transition of enrolled children to national health care reform mandated eligibility criteria is complete.

Washington State Code Reviser's Office