WSR 99-14-082

PROPOSED RULES

HEALTH CARE AUTHORITY


[ Order 99-03-- Filed July 7, 1999, 11:23 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 99-11-100.

Title of Rule: Chapter 182-08 WAC, Procedures.

Purpose: Revise WAC 182-08-095 to condense rules into one standard for waiving medical coverage.

Statutory Authority for Adoption: Chapter 41.05 RCW.

Statute Being Implemented: RCW 41.05.160.

Summary: Condensing rules for different eligible groups into one standard for waiving medical coverage.

Name of Agency Personnel Responsible for Drafting: Mich'l Needham, Health Care Authority, 923-2735; Implementation 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: Condensing rules for different eligible groups into one standard for waiving medical coverage to allow employees of political subdivisions enrolled in PEBB coverage the opportunity to waive medical coverage if they have other medical coverage, like state employees. This will streamline administration of the program with one standard applied to all employees and reduce paperwork to one standard form.

Proposal Changes the Following Existing Rules: The change will allow individual political subdivision employees to waive their PEBB medical coverage if they have other coverage, like state employees.

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 costs to businesses will be negligible.

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

Hearing Location: Tyee Hotel, Skokomish Room, Tumwater, Washington, on August 10, 1999, at 1:00 p.m.

Assistance for Persons with Disabilities: Contact Nikki Johnson by August 4, 1999, TDD (888) 923-5622, or (360) 923-2805.

Submit Written Comments to: Mich'l Needham, fax (360) 923-2602, by August 17, 1999.

Date of Intended Adoption: September 4, 1999.

July 7, 1999

Elin Meyer

Rules Coordinator

OTS-3179.1


AMENDATORY SECTION(Amending WSR 97-21-126, filed 10/21/97, effective 11/21/97)

WAC 182-08-095
Waiver of coverage.

(((1) State employees:)) Employees eligible for PEBB health care coverage have the option of waiving medical coverage for themselves and any or all dependents if they are covered by another medical plan.  In order to waive medical coverage, the employee must complete an enrollment form that identifies the individuals for whom coverage is being waived.  If an employee waives medical coverage for him/herself, coverage is automatically waived for all eligible dependents.  An employee may choose to enroll only him/herself, and waive medical coverage for any or all dependents.

Employees and dependents whose medical coverage is waived will remain enrolled in a PEBB dental plan.  Employees will also remain enrolled in PEBB life and long term disability coverage.

If PEBB medical coverage is waived, an otherwise eligible person may not enroll in a PEBB plan until the next open enrollment period, or within 31 days of loss of other medical coverage.  Proof of other medical coverage is required to demonstrate that: 1) Coverage was continuous from the date PEBB coverage was waived; and 2) the period between loss of coverage and application for PEBB coverage is 31 days or less.  The employee and dependents may have an additional opportunity to enroll in the event of acquisition of a new dependent as a result of marriage, birth, adoption, or placement for adoption, provided that enrollment is requested within 31 days of marriage or within 60 days of birth, adoption or placement for adoption.

(((2) K-12 employees: Employees eligible for PEBB health care coverage have the option of waiving medical coverage for themselves and any or all dependents.  In order to waive medical coverage, the employee must complete an enrollment form that identifies the individuals for whom coverage is being waived.  If an employee waives medical coverage for him/herself, coverage is automatically waived for all eligible dependents.  An employee may choose to enroll only him/herself, and waive medical coverage for any or all dependents.

Employees and dependents whose medical coverage is waived will remain enrolled in a PEBB dental plan if the district/unit participates in the dental plan.  Employees will also remain enrolled in life and long term disability coverage if the district/unit participates in those plans.

If PEBB medical coverage is waived, an otherwise eligible person may not enroll in a PEBB plan until the next school district renegotiation period, or upon approval of the participating school district and the HCA.  Approval of the HCA will require proof of other medical coverage to demonstrate that: 1) Coverage was continuous from the date PEBB coverage was waived; and 2) the period between loss of coverage and application for PEBB coverage is 31 days or less.  The employee and dependents may have an additional opportunity to enroll in the event of acquisition of a new dependent as a result of marriage, birth, adoption, or placement for adoption, provided that enrollment is requested within 31 days of marriage or within 60 days of birth, adoption or placement for adoption.

(3) Political subdivision employees: Political subdivision employees may not waive PEBB medical coverage for themselves, but may waive medical coverage for their dependents if the dependents are covered by another medical plan.  In order to waive medical coverage for dependents, the employee must complete an enrollment form that identifies the individuals for whom coverage is being waived.

Dependents whose medical coverage is waived will remain enrolled in their PEBB dental plan.

If PEBB medical coverage is waived, an otherwise eligible dependent may not enroll in a PEBB medical plan until the next open enrollment period, or within 31 days of loss of other medical coverage.  Proof of other medical coverage is required to demonstrate that: 1) Coverage was continuous from the date PEBB coverage was waived; and 2) the period between loss of coverage and application for PEBB coverage is 31 days or less.  The employee and dependents may have an additional opportunity to enroll in the event of acquisition of a new dependent as a result of marriage, birth, adoption, or placement for adoption, provided that enrollment is requested within 31 days of marriage or within 60 days of birth, adoption or placement for adoption.))

[Statutory Authority: RCW 41.05.160.  97-21-126, 182-08-095, filed 10/21/97, effective 11/21/97.  Statutory Authority: Chapter 41.05 RCW.  96-08-042, 182-08-095, filed 3/29/96, effective 4/29/96.]

Washington State Code Reviser's Office