WSR 13-12-046



(Public Employees Benefits Board)

[ PEBB Admin 2013-01 -- Filed May 31, 2013, 10:37 a.m. ]

     Subject of Possible Rule Making: Public employees benefits board (PEBB) rules related to enrollment in chapter 182-08 WAC; eligibility in chapter 182-12 WAC; and appeals in chapter 182-16 WAC.

     Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 41.05.160.

     Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: The health care authority (HCA) will consider amendments to PEBB rules to address the following:

Allowing non-Medicare retirees to defer enrollment in PEBB retiree insurance if enrolled in coverage through an American Health Benefit Exchange if a policy is adopted by PEBB.
Eligibility of stepchildren following divorce or death of the parent.
Clarify that when the department of retirement systems (DRS) issues a formal determination of retroactive eligibility, the retiree must still satisfy retiree insurance eligibility under WAC 182-12-171.
Expand the provisions of WAC 182-12-211 to include employees awarded a retroactive disability retirement under a higher education retirement plan if a policy is adopted by PEBB.
A technical correction so it is clear that a retiree who is enrolled in a PEBB or Washington state K-12 health plan as a dependent or an employee does not need to submit a form to defer enrollment in PEBB retiree insurance.
The definition of child and consider a closer alignment to the definition of child to RCW 26.26.101 which includes the many different ways that a parent-child relationship can be established.
The employer group application process as it relates to school districts required by the office of the superintendent of public instruction to purchase through PEBB.
A comprehensive error correction policy to address when an employing agency fails to provide notice of benefits eligibility or fails to enroll an eligible employee when enrollment forms are received or are not received. This will include implementing any PEBB policy limiting retroactive medical and dental enrollment to a maximum of three months and exceptions to default medical and dental plan enrollment or employee elections under certain circumstance.
Clarify the meaning of the term federal retiree plan as it is used in WAC 182-12-205.
Amend special open enrollment rules to allow a coverage effective date of the first day of the month under certain circumstances.
That a change to a collective bargaining agreement may affect faculty eligibility.
Clarify that blind vendors are not eligible for PEBB retiree insurance when they end participation in the business enterprises program.
Clarify that if an employer group application is for a bargaining unit, the bargaining unit will be evaluated as a unit in addition to all eligible employees of the employer being evaluated as a single unit.

     HCA will conduct a full review of PEBB program rules in these chapters and make changes as necessary to provide technical corrections, implement legislation, implement PEBB policy and to comply with federal or state regulations.

     Process for Developing New Rule: HCA welcomes the public to take part in developing the rules. Anyone interested should contact the staff person identified below. At a later date, HCA will file a notice of proposed rule making (CR-102) with the office of the code reviser. A copy of the proposal will be sent to everyone on the mailing list and to anyone who requests a copy.

     Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication. Individuals wishing to receive PEBB rule-making notices are encouraged to join our listserv, PEBB-RULE-MAKING-NOTICE, via this link or by logging on to and selecting our listserv from the public e-mail list. If you have questions about this rule making, contact Barbara Scott at (360) 725-0830 or Rob Parkman at (360) 725-0883 or at HCA, P.O. Box 42684, Olympia, WA 98504-2684, fax (360) 586-9727, TTY 1-800-848-5429, e-mail or

May 31, 2013

Kevin M. Sullivan

Rules Coordinator