The following is a list of administrative policies published by the public employees benefits board (PEBB) program. These policies are effective January 1, 2021. You can download the complete policy statements on the PEBB program rules and policies page at hca.wa.gov/pebb-rules.

Policy 11-1: Providing a notice to an employee and a state agency. To clarify the requirements of a state agency-to-employee and employee-to-state agency notice, as stated in WAC 182-12-113(2), and RCW 41.05.009(2) and 41.05.065 (4)(c)(iii), (iv), and (v).

Policy 11-3:Correcting employing agency and contracted vendor enrollment errors. This policy clarifies the requirements placed on an employing agency or contracted vendor when they correct their own enrollment errors as described in WAC 182-08-187.

Policy 17-2: Determining faculty eligibility after a layoff. This policy applies the criteria for maintaining the employer contribution toward insurance coverage for faculty following a layoff, as described in WAC 182-12-129, to: (1) Faculty who move from one position to another due to a layoff; and (2) employees who move from any type of position to a faculty position after a layoff.

Policy 17-3: Determining faculty eligibility for off-quarter/semester or for decreases in workload. This policy clarifies when a faculty member qualifies for the employer contribution toward the PEBB program benefits during an off-quarter/semester or when there is a decrease in workload.

Policy 19-1: Termination due to loss of eligibility or enrollment error. This policy applies whenever coverage for a subscriber or a subscriber's dependent is terminated due to loss of eligibility, or because a subscriber or dependent was enrolled when they were not eligible for coverage.

Policy 21-1: Exemption from the retiree deferral form requirement. This policy exempts certain retirees from the "deferral form requirement" under WAC 182-12-171 (1)(d), 182-12-180 (3)(d), and 182-12-205 (4)(a).

Policy 26-1: Administering PEBB retiree medical plan enrollment in coordination with Medicare Part D. This policy administers PEBB program retiree medical plan enrollment in order to participate in the employer incentive program established in 42 U.S.C. § 1395w-132.

Policy 31-1: Verifying dependent eligibility before enrollment. This policy clarifies which documents the PEBB program considers valid for dependent verification and identifies which accounts are included in the dependent verification process.

Policy 33-1: Verifying legal union's residency status. This policy sets forth special criteria, documentation criteria, and limitations for two persons in Washington state who have a legal union, other than a marriage, that was: (1) Validly formed in another state or jurisdiction; (2) provides substantially the same rights, benefits, and responsibilities as a marriage; and (3) does not meet the definition of a domestic partnership in RCW 26.60.030.

Policy 36-1: Certifying eligibility for a dependent child with a disability who is age twenty-six or older. This policy applies whenever a subscriber requests to enroll or continue enrollment for a dependent child with a disability who is age twenty-six or older on their PEBB program subscriber account.

Policy 37-1: Certifying eligibility for an extended dependent child. This policy applies when a subscriber submits the required forms to enroll an extended dependent child in the subscriber's PEBB health plan coverage.

Policy 45-2: Special open enrollment. This policy applies whenever a subscriber requests an enrollment change or election change outside of the PEBB program annual open enrollment period.

Policy 56-1: Continuation coverage and retiree insurance coverage reinstatement for subscribers with mental or physical impairment or incapacitation. This policy applies whenever a subscriber (or another party acting on behalf of the subscriber) requests reinstatement of continuation coverage or retiree insurance coverage due to nonpayment of premiums, or applicable premium surcharges, for reason of mental or physical impairment or incapacitation.

This policy establishes the methodology that the PEBB program will use to make a determination of mental or physical impairment or incapacitation for the purpose of reinstatement of coverage terminated due to nonpayment of premiums, or applicable premium surcharges.

This policy provides timing requirements for requesting reinstatement due to nonpayment of premiums, or applicable premium surcharges, for reason of mental or physical impairment or incapacity.

Policy 56-2: Election period tolling for applicants with mental or physical impairment or incapacitation. This policy applies whenever an applicant (or another party acting on behalf of the applicant) requests tolling of the continuation coverage, retiree insurance coverage, new employee eligibility, regained eligibility, annual open enrollment or special open enrollment election period for reason of mental or physical impairment or incapacitation.

This policy establishes the methodology that the PEBB program will use to make a determination of mental or physical impairment or incapacitation for the purpose of tolling the election period of continuation coverage, retiree insurance coverage, new employee eligibility, annual open enrollment, or special open enrollment.

This policy provides timing requirements to request tolling of the election period for reason of mental or physical impairment or incapacity.

Policy 90-1: Allowable mid-year termination for an employer group or board members of school districts and educational service districts. This policy clarifies when an employer group or board members of school districts or educational service districts may terminate their participation in PEBB program insurance coverage mid-year.

Policy 90-2: What authority do employer groups, educational service districts for nonrepresented employees, or board of directors for school districts and educational service districts need before contracting with the Health Care Authority (HCA) for participation in PEBB for insurance coverage? This policy clarifies what authority is required from employer groups, educational service districts for nonrepresented employees, or board members of school districts and educational service districts as part of the application process for benefits with HCA and the PEBB program.

Policy 90-3: Determining if an employer group, educational service districts for nonrepresented employees, or board of directors for school districts and educational service districts requesting eligibility standards different from PEBB program rules shall be approved. This policy clarifies the criteria used by HCA to approve or deny requests by employer groups for eligibility standards that are different eligibility standards than standards used by the PEBB program.

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 program's 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 program medical plan is seeking a reasonable alternative so that a subscriber can avoid paying the tobacco use premium surcharge as described in WAC 182-08-185 (1)(c)(iii).

Policy 91-3: Washington wellness worksite designation program incentive requirements. This policy provides a set of requirements for state agencies to use when offering wellness incentives under the Washington wellness worksite designation program.

Policy 93-2: PEBB program payment plans for continuation coverage and retiree accounts. This policy describes the process the HCA will use when authorizing a payment plan request for a continuation coverage or a retiree account from a subscriber or a subscriber's legal representative.

To receive a hard copy of the policy statements, contact Stella Ng at P.O. Box 42684, Olympia, WA 98504-2684, or via email at Stella.Ng@hca.wa.gov.