HEALTH CARE AUTHORITY
[Filed February 28, 1997, 11:40 a.m.]
Date of Adoption: February 28, 1997.
Purpose: To amend eligibility language to include reference to WAC 182-08-175 and to clarify group coverage.
Citation of Existing Rules Affected by this Order: Amending WAC 182-08-160 and 182-08-175.
Statutory Authority for Adoption: Chapter 41.05 RCW.
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: Consistency with chapter 41.05 RCW.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 0, repealed 0; Federal Rules or Standards: New 0, amended 0, repealed 0; or Recently Enacted State Statutes: New 0, amended 0, repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, amended 2, repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, amended 2, repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, amended 0, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 0, amended 0, repealed 0.
Effective Date of Rule: Immediately.
February 28, 1997
AMENDATORY SECTION (Amending WSR 96-08-042, filed 3/29/96, effective
WAC 182-08-160 Group coverage when not in pay status. Employees covered by a PEBB health plan have options for providing continued coverage for themselves and their dependents during temporary or permanent loss of eligibility. With the exception of approved family and medical leave, employees not in pay status for at least 8 hours per month are ineligible to receive the employer premium contribution:
(1) When an employee loses eligibility as an active employee, PEBB group coverage, except long-term disability, may be continued at the group premium rate by self-paying premiums for medical coverage only, or for medical and dental combined, or for dental only, and on life insurance for a maximum of 29 months. With respect to medical and dental coverage, the maximum time shall be reduced by the number of months of self-pay allowed under COBRA and the number of employer-paid months allowed under family and medical leave. Part-time faculty may self-pay for group coverage between periods of active employee eligibility for a maximum of 18 months. If an employee is temporarily not in pay status for any of the following reasons, he or she may continue PEBB group coverage by self-paying the premium:
(a) The employee is on authorized leave without pay,
(b) The employee is laid off because of a reduction in force (RIF)
(c) The employee is receiving time-loss benefits under workers' compensation
(d) The employee is awaiting hearing for a dismissal action
(e) The employee is applying for disability retirement
(2) The federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) gives enrollees the right to continue group coverage for a period of 18 to 36 months.
(3) The Family and Medical Leave Act of 1993 gives the enrollee the
opportunity to extend eligibility with employer contribution toward
premium for up to 12 weeks, see WAC ((
(4) Enrollees have the right to convert to individual medical coverage when continuation of group medical coverage is no longer possible.
(5) The dependents of employees also have options for continuing coverage for themselves following loss of eligibility.
(6) Employees who revert to a previously held position and do not regain pay status during the last month in which their employer contribution is made may continue their PEBB-sponsored health and life coverage, by self-paying premium for up to 18 months (and in some cases up to 29 months).
(7) If a dependent(s) loses eligibility 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 employee's spouse may continue coverage indefinitely; other dependents may continue coverage until they lose eligibility under PEBB rules. Application for surviving dependent coverage must be made within 60 days from the death of the employee. If a dependent is not eligible for a monthly retirement income benefit, or a lump-sum payment because the monthly pension payment would be less than $50, the dependent may be eligible for continued coverage under COBRA.
(8) An employee may retain long-term disability coverage by self-payment of premium up to twenty-four months during an authorized leave
without pay, but only if such leave is an approved educational leave.
[Statutory Authority: Chapter 41.05 RCW. 96-08-042, 182-08-160, filed
3/29/96, effective 4/29/96; 93-23-065, 182-08-160, filed 11/16/93,
effective 12/17/93; 86-16-061 (Resolution No. 86-3), 182-08-160, filed
8/5/86; 83-22-042 (Resolution No. 6-83), 182-08-160, filed 10/28/83;
80-01-082 (Order 5-79), 182-08-160, filed 12/27/79; 78-03-021 (Order
3-78), 182-08-160, filed 2/14/78; Order 7228, 182-08-160, filed
AMENDATORY SECTION (Amending WSR 93-23-065, filed 11/16/93, effective
WAC 182-08-175 Group coverage while on family and medical leave.
Employees on leave under the federal Family and Medical Leave Act of
1993, and regulations implementing that act, shall continue to receive
up to twelve weeks of employer-paid group medical, dental, basic life,
and basic long-term disability insurance while on family and medical
leave and may self-pay their optional life and long-term disability. If
an employee fails to return to work after expiration of family and
medical leave for a reason other than the continuation, recurrence, or
onset of a serious health condition or other circumstance beyond the
control of the employee, the employer may recover the premiums paid to
maintain the employee's insurance coverage from the employee.
[Statutory Authority: Chapter 41.05 RCW. 93-23-065, 182-08-175, filed 11/16/93, effective 12/17/93.]