WSR 00-21-074

PROPOSED RULES

HEALTH CARE AUTHORITY


[ Order 00-02 -- Filed October 17, 2000, 9:29 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 00-12-045.

Title of Rule: Chapter 182-12 WAC, Eligible and noneligible employees.

Purpose: Amend WAC 182-12-119, defining eligible dependents to include same-sex domestic partners, and to simplify extended dependent eligibility; and amend WAC 182-12-132 to modify administration of the retiree program all in accordance with the May 23, 2000, vote of the Public Employees Benefits Board.

Statutory Authority for Adoption: Chapter 41.05 RCW.

Statute Being Implemented: RCW 41.05.160.

Summary: Modify eligibility requirements for calendar year contracts, allowing coverage for same-sex domestic partners, simplifying requirements for extended dependents, and modifying retiree options to allow waiver of coverage.

Reasons Supporting Proposal: These amendments are being made in accordance with the vote of the Public Employees Benefits Board on May 23, 2000.

Name of Agency Personnel Responsible for Drafting and Implementation: Mich'l Needham, Health Care Authority, 923-2735; and Enforcement: MaryAnne Lindeblad, Health Care Authority, 923-2640.

Name of Proponent: Health Care Authority, governmental.

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

Explanation of Rule, its Purpose, and Anticipated Effects: Language was added to add same-sex domestic partners to the definition of eligible dependents for coverage under the employee's benefit package to ensure equitable benefits for all employees. Extended dependent eligibility was simplified to ensure legally recognized dependents can be covered on the insurance despite their potential eligibility for Medicaid.

Retiree enrollment requirements were modified to allow greater flexibility for retirees and their dependents enrolled in other employer sponsored medical coverage. This rule change will bring retiree enrollment options in-line with the other enrollment requirements and allow for easier administration of the retiree program.

These amendments are being made to implement a vote of the Public Employees Benefits Board on May 23, 2000.

Proposal Changes the Following Existing Rules: The rule change will expand dependent eligibility to include same-sex domestic partners, streamline requirements for members making application for extended dependent enrollment, and remove the requirement for retiree's and their dependents enrolled in another employer sponsored medical plan to duplicate coverage by enrolling in a PEBB sponsored medical plan as a means to secure future access to the program.

These amendments implement a vote of the Public Employees Benefits Board on May 23, 2000.

No small business economic impact statement has been prepared under chapter 19.85 RCW. Not required. The Joint Administrative Rules Review Committee has not requested the filing of a small business economic impact statement, and there will be no costs to small businesses.

RCW 34.05.328 does not apply to this rule adoption. RCW 34.05.328 does not apply to Health Care Authority (HCA) rules unless requested by the Joint Administrative Rules Review Committee or applied voluntarily by the HCA.

Hearing Location: Lacey Community Center, Lacey, Washington, on November 28, 2000, at 1:00 p.m.

Assistance for Persons with Disabilities: Contact Nikki Johnson by November 21, 2000, TDD (888) 923-5622, or (360) 923-2805.

Submit Written Comments to: Barbara Scott, PEBB Program, 676 Woodland Square Loop S.E., Building B, Olympia, WA 98504, fax (360) 923-2602, by November 21, 2000.

Date of Intended Adoption: December 19, 2000.

October 17, 2000

Melodie Bankers

Rules Coordinator

OTS-4455.2


AMENDATORY SECTION(Amending Order 99-04, filed 9/8/99, effective 10/9/99)

WAC 182-12-119
Eligible dependents.

"Eligible dependents." The following are eligible as dependents under the PEBB eligibility rules:

(1) Lawful spouse or "qualified domestic partner" (same sex domestic partner qualified through the declaration certificate issued by the health care authority).

(2) Dependent children through age nineteen. The term "children" includes the subscriber's natural children, stepchildren, legally adopted children, children for whom the subscriber has assumed a legal obligation for total or partial support of a child in anticipation of adoption of the child, children of the subscriber's qualified domestic partner, or children specified in a court order or divorce decree. Married children who qualify as dependents of the subscriber under the Internal Revenue Code, and extended dependents approved by the HCA are included. To qualify for HCA approval, the subscriber must demonstrate legal custody for the child with a court order, and:

(a) Be living with the subscriber in a parent-child relationship;

(b) Be dependent upon the subscriber for financial support; and

(c) ((Not be eligible for coverage under Medicare, Medicaid, or similar government entitlement programs; and

(d))) Not be a foster child for whom support payments are made to the subscriber through the state department of social and health services (DSHS) foster care program.

(3) Dependent children age twenty through age twenty-three who are dependent upon the employee/retiree for maintenance and support, and who are registered students in full-time attendance at an accredited secondary school, college, university, vocational school, or school of nursing. Dependent student eligibility continues year-round for those who attend three of the four school quarters or two semesters and for the quarter following graduation provided the employee/retiree is covered at the same time; the dependent limiting age has not been exceeded; and the dependent meets all other eligibility requirements.

(4) Dependent children of any age who are incapable of self-support due to developmental or physical disability, provided such condition occurs prior to age twenty or during the time the dependent was covered under a PEBB plan as a full-time student. Proof of such disability and dependency must be furnished prior to the dependent's attainment of age twenty or loss of eligibility for student coverage, and as periodically requested thereafter.

(5) Dependent parents. Dependent parents covered under a PEBB medical plan before July 1, 1990, may continue enrollment on a self-pay basis as long as:

(a) The parent maintains continuous coverage in a PEBB-sponsored medical plan;

(b) The parent continues to qualify under the Internal Revenue Code as a dependent of an eligible subscriber;

(c) The subscriber who claimed the parent as a dependent continues enrollment in a PEBB program; and

(d) The parent is not covered by any other group medical insurance. Dependent parents may be enrolled in a different PEBB plan than that selected by the eligible subscriber; however, dependent parents may not add additional family members to their coverage.

(6) Surviving dependents.

(a) The following surviving dependents may continue their medical and dental coverages on a self-pay basis:

(i) If a dependent loses eligibility under a PEBB plan due to the death of the employee, the dependent(s) may continue coverage under a retiree plan provided the dependent(s) will immediately begin receiving a monthly benefit from any state of Washington-sponsored retirement system (the Federal Civil Service Retirement System shall be considered a Washington sponsored retirement system for Washington State University cooperative extension service employees who held a federal civil service appointment and who were covered under the PEBB program at the time of death).

(ii) If a surviving dependent of a PEBB employee is not eligible for a monthly retirement income benefit, or lump-sum payment because the monthly pension payment would be less than $50, the dependent may be eligible for continued coverage under COBRA.

(iii) Dependents of retirees ((covered under a PEBB plan)) enrolled in the retiree's PEBB plan or waiving coverage under a PEBB plan while eligible for an employer sponsored medical plan at the time of the retiree's death are eligible to continue PEBB retiree coverage.

(iv) Surviving spouses and/or eligible dependent children of a deceased school district or educational service district employee who were not enrolled in a PEBB plan at the time of death may continue coverage provided the employee died on or after October 1, 1993 and the dependent(s) immediately began receiving a retirement benefit allowance under chapter 41.32 or 41.40 RCW.

(b) Application for surviving dependent(s) coverage must be made in writing on the enrollment form approved by the health care authority within sixty days from the date of death of the employee or retiree. Coverage is retroactive to the date the employee or retiree coverage terminated subject to the payment of the premium. In order to avoid duplication of group medical coverage, surviving dependents may defer or waive their enrollment in the PEBB coverage each full calendar month in which they maintain coverage under an employer sponsored medical plan. Notice of intent to waive PEBB coverage must be sent in writing to the Washington state health care authority. When an employer sponsored medical plan ends, surviving dependent(s) must submit an application to enroll in a PEBB plan within sixty days of the last day of coverage under the employer sponsored medical plan. Satisfactory evidence of continuous enrollment in an employer sponsored medical plan will be required by the Washington state health care authority prior to enrollment in a PEBB plan. The employee's or retiree's spouse or qualified domestic partner may continue coverage indefinitely; other dependents may continue coverage until they lose eligibility under PEBB rules.

[Statutory Authority: RCW 41.05.160. 99-19-028 (Order 99-04), 182-12-119, filed 9/8/99, effective 10/9/99; 97-21-127, 182-12-119, filed 10/21/97, effective 11/21/97. Statutory Authority: Chapter 41.05 RCW. 96-08-043, 182-12-119, filed 3/29/96, effective 4/29/96.]


AMENDATORY SECTION(Amending WSR 97-21-127, filed 10/21/97, effective 11/21/97)

WAC 182-12-132
((Retirees returning to state employment.)) Waiving or deferring coverage.

((If a retiree returns to work and is again eligible for employer contributions towards their PEBB or Washington state school district sponsored benefits the retiree may cancel their retirement deduction for health coverage as soon as eligibility is established and the retiree is enrolled as an active employee. The retiree must maintain)) Retirees may waive PEBB medical and dental coverage for themselves and all dependents if they are covered under another comprehensive employer sponsored medical plan. (Other coverage may be attained through the retiree's reemployment or the spouse's employment.) In order to continue retiree term life coverage ((during active employment in order to retain it at retirement)), coverage must be selected upon retirement and premiums must continue to be paid during reemployment status. When the retiree again ceases active employment, the retiree ((must reenroll)) may enroll in ((a)) PEBB ((retiree plan)) medical and dental coverage with evidence of continuous coverage within ((60)) sixty days of the loss of coverage. Coverage will become effective the first of the month following the date other coverage ended.

[Statutory Authority: RCW 41.05.160. 97-21-127, 182-12-132, filed 10/21/97, effective 11/21/97. Statutory Authority: Chapter 41.05 RCW. 96-08-043, 182-12-132, filed 3/29/96, effective 4/29/96; 80-05-016 (Order 2-80), 182-12-132, filed 4/10/80.]

Washington State Code Reviser's Office