HEALTH CARE AUTHORITY

(Public Employees Benefits Board)

[Admin #2023-03.01—Filed September 20, 2023, 3:58 p.m., effective September 20, 2023, 3:58 p.m.]

Effective Date of Rule: Immediately upon filing.

Purpose: The health care authority (HCA) is refiling WAC 182-12-5000 Retirees who regained eligibility for public employees benefits board (PEBB) retiree insurance coverage, as authorized in SSB 5490, chapter 15, Laws of 2023, 68th legislature, 2023 regular session.

Citation of Rules Affected by this Order: New WAC 182-12-5000.

Statutory Authority for Adoption: SSB 5490, chapter 15, Laws of 2023, 6th [68th] legislature, 2023 regular session.

Other Authority: RCW 41.05.021 and 41.05.160.

Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest.

Reasons for this Finding: This emergency rule making is necessary to preserve the public peace, health, or safety, or support of the state government and its existing public institutions by establishing rules to implement the special enrollment opportunity for retired or disabled employees who were denied coverage for failure to timely notify HCA of their intent to defer coverage and who appealed the denial of benefits to HCA on or before December 31, 2022. The emergency rule is necessary to implement SSB 5490, chapter 15, Laws of 2023, while the authority conducts the permanent rule-making process.

This filing continues the emergency rules filed under WSR 23-12-019, filed May 25, 2023. Since the filing of this emergency rule, HCA is continuing to review the PEBB chapters for updates and is preparing for its annual revisions to begin under permanent rule making shortly.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 1, Amended 0, Repealed 0.

Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 0.

Date Adopted: September 20, 2023.

WAC 182-12-5000Retirees who regained eligibility for public employees benefits board (PEBB) retiree insurance coverage under chapter 15, Laws of 2023 (SSB 5490).

(1) For this section only, "subscriber" means a retired or disabled employee who:

(a) Is receiving a retirement allowance under chapter 41.32, 41.35, 41.37, or 41.40 RCW;

(b) Was previously denied coverage solely for failure to timely notify the health care authority (HCA) of their plan to defer public employees benefits board (PEBB) retiree insurance coverage;

(d) Is eligible for and enrolled in medicare Parts A and B.

(2) Subscribers may enroll only in a medicare advantage (MA), medicare advantage-prescription drug (MA-PD), or a medicare supplement plan. Subscribers may also enroll their dependents who are eligible under WAC 182-12-260 and must include the dependent's enrollment information on the required forms.

(a) The dependent must be enrolled in the same PEBB medical plan as the subscriber;

(b) If the subscriber selects a medicare supplement plan or MA-PD plan, nonmedicare enrollees will be enrolled in the UMP Classic plan. If the subscriber selects any other medicare plan, the subscriber must also select a nonmedicare plan with the same contracted vendor available to nonmedicare enrollees.

(3) The subscriber must submit the required forms to enroll in PEBB retiree insurance coverage and they must be received by the PEBB program by November 30, 2023.

(a) If the subscriber elects to enroll in a medicare supplement plan, the effective date of PEBB retiree insurance coverage described in this section is the first day of the month following the date the PEBB program receives the required forms. If the required forms are received on the first day of the month, the effective date of PEBB retiree insurance coverage is that day.

(b) Enrollment in the PEBB program's MA or MA-PD plan may not be retroactive. If the subscriber elects to enroll in a MA or MA-PD plan, coverage will be effective the first of the month following the signature date on the form.

(4) Subscribers may enroll in a PEBB dental plan if they also enroll in a MA or MA-PD plan or medicare supplemental plan. Subscribers may also enroll their dependents who are eligible under WAC 182-12-260 and must include the dependent's enrollment information on the required forms.

(5) The subscriber's first premium payment for PEBB retiree insurance coverage is due to the HCA no later than 45 days after the effective date of PEBB retiree insurance coverage as described in subsection (3) of this section. Following the subscriber's first premium payment, premiums must be paid as described in WAC 182-08-180 (1)(a).

(6) Subscribers are not eligible to elect retiree term life insurance as described in WAC 182-12-209.

(7) Once enrolled in PEBB retiree insurance coverage, subscribers and their dependents are subject to all applicable rules in chapters 182-08, 182-12, and 182-16 WAC.