WSR 14-24-101

POLICY STATEMENT

[Filed December 2, 2014, 10:39 a.m.]

Notice of Administrative Policy Statements

The following is a list of administrative policies issued by the public employees benefits board (PEBB) program. These policies are effective January 1, 2015. You can download the complete policy statements at www.hca.wa.gov/pebb/Pages/policy.aspx.

Policy #11-3: Correcting employing agency enrollment errors. This policy clarifies the requirements placed on an employing agency when the employing agency corrects its enrollment errors as described in WAC 182-08-187.

Policy #15-1: Determining eligibility for seasonal employees and maintenance of employer contribution through the off-season. To clarify seasonal employee eligibility for PEBB benefits and the employer contribution.

Policy #19-1: Termination due to loss of eligibility. This policy applies whenever coverage for a subscriber or a subscriber's dependent is terminated due to loss of eligibility.

Addendum #19-1A: Termination due to loss of eligibility: Employee.

Addendum #19-1B: Termination due to loss of eligibility: Self-Pay Subscriber.

Policy #21-1: Retiree deferral form exemption. This policy exempts certain retirees from the procedural requirement of completing a deferral form in WAC 182-12-171 (1)(a) and 182-12-205(2).

Policy #26-1: Administering PEBB insurance in coordination with Medicare Part D. 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 #31-1: Verifying dependent eligibility before enrollment. This policy clarifies which documents the PEBB program considers valid for dependent verification. 

Policy #31-2: Use of Spousal Plan Questionnaire and Calculator Tools. This policy provides direction when a PEBB subscriber, who is not enrolled in Medicare Part A and Part B, is determining if he or she must pay a premium surcharge for an enrolled spouse or registered domestic partner who chose not to enroll in his or her employer-based group medical insurance.

Policy #36-1: Certifying eligibility for a dependent child with a disability who is age 26 or older. This policy applies whenever a subscriber requests to enroll a dependent child with a disability who is age twenty-six and older to his or her PEBB subscriber account.

Policy #45-2: Special Open Enrollment (SOE). This policy applies whenever a subscriber requests an enrollment change or election change outside of the PEBB annual open enrollment.

Addendum #45-2A: Special Open Enrollment (SOE) Matrix: Summary of Permitted Changes.

Policy #91-1: Requesting a reasonable alternative for completing wellness incentive program requirements or avoiding the tobacco use premium surcharge. This policy applies when a subscriber who is eligible to participate in the PEBB wellness incentive program is seeking a reasonable alternative to a wellness incentive program requirement in order to receive a wellness incentive as described in WAC 182-12-300. This policy also applies when an enrollee on a PEBB medical plan is seeking a reasonable alternative so that a subscriber can avoid paying the tobacco premium surcharge as described in WAC 182-08-185(1).

The PEBB program is rescinding the following policies:

Policy #45-4: FSA Special Open Enrollment due to a Change in the Legal Status of a Same-Sex Spouse. To allow employees to make an SOE election under the medical flexible spending account (FSA) for the 2013 plan year due to a change in the legal status of their same-sex spouse.

Policy #70-1: Postponement of various due dates for certain individuals affected by the SR 530 mudslide. To provide relief to "affected individuals" in the "disaster area" by changing due dates occurring on or after March 22, 2014, for premium payments, form submissions, elections, attestations, appeals, eligibility verification documents, and wellness activity requirements to the later of the original due date or August 29, 2014.

Policy #70-2: Postponement of various due dates for certain individuals affected by the Washington state wildfires. To provide relief to "affected individuals" in the "disaster area" by postponing due dates occurring on or after July 9, 2014, for premium payments, form submissions, elections, attestations, appeals, eligibility verification documents, and wellness activity requirements to the later of the original due date or October 31, 2014.

To receive a hard copy of the policy statements, contact Rob Parkman at 626 8th Avenue S.E., Olympia, WA 98501-2684, phone (360) 725-0883.