Original Notice.

Preproposal statement of inquiry was filed as WSR 01-18-094.

Title of Rule: WAC 182-08-095 Waiver of coverage and new section WAC 182-08-125 PEBB-sponsored medical and dental benefit is limited to one enrollment per individual member.

Purpose: To amend WAC 182-08-095 by striking the words "and dependents." Propose new section WAC 182-08-125 based on 2001 legislation and the vote at the August 7, 2001, PEBB board meeting, which eliminated "dual eligibility" for persons eligible for PEBB-sponsored health coverages. These changes are necessary to effectuate this change.

Statutory Authority for Adoption: RCW 41.05.160.

Statute Being Implemented: RCW 41.05.065.

Summary: WAC 182-08-095 is proposed to be amended by striking the words "and dependents."

New section WAC 182-08-125 is proposed to limited dual-eligibility in PEBB-sponsored coverage.

Reasons Supporting Proposal: These changes are necessary to effectuate the 2001-2003 biennial budget and the August 7, 2001, vote of the PEBB board.

Name of Agency Personnel Responsible for Drafting and Implementation: Barbara Scott, Health Care Authority, (360) 923-2642; and Enforcement: MaryAnne Lindeblad, Health Care Authority, (360) 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: When the 2001 legislature adopted the 2001-2003 biennial budget, assumed elimination of "dual eligibility" for persons eligible for PEBB-sponsored coverage. These changes are necessary to effectuate this change.

WAC 182-08-095 is proposed to be amended by striking "and dependents." As a result, eligible PEBB active employees will have the ability to waive dental coverage for eligible dependents. The current rule does not permit waiving of dependent dental coverage.

A new section, WAC 182-08-125, is proposed. This section will limit enrollment in medical and dental coverages to one enrollment, thereby eliminating "dual eligibility." As a result, eligible employees of state government, higher education, and PEBB-participating K-12 school districts, educational school districts, political subdivisions and employee organizations representing state civil service workers, will not be eligible for coverage as both an employee and a dependent of an employee.

Originally, it seemed appropriate to amend WAC 182-08-095, however, upon further examination it was determined that a separate rule would make it easier for affected persons to find the requirement.

Proposal Changes the Following Existing Rules: The current rule does not permit waiving dependent dental and does not preclude multiple enrollments by members with more than one source of eligibility for PEBB-sponsored medical and dental benefits. The new rule allows the employee to waive dependent dental and limits individual members to one PEBB enrollment, effective January 1, 2002.

See Explanation of Rule above.

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.

Hearing Location: Health Care Authority, Executive Conference Room, 4th Floor, 600 Woodland Square Loop, Lacey, WA, on November 27, 2001, at 1:00 p.m. This will be a teleconference hearing. Please call Cyndi Presnell at (360) 923-2802 for the teleconference number.

Assistance for Persons with Disabilities: Contact Nikki Johnson by November 21, 2001, TDD (888) 923-5622, or (360) 923-2805.

Submit Written Comments to: Barbara Scott, Health Care Authority, 676 Woodland Square Loop S.E., Olympia, WA 98504-2684, fax (360) 923-2602, by close of business on November 27, 2001.

Date of Intended Adoption: November 28, 2001.

October 24, 2001

Cyndi L. Presnell

for Melodie H. Bankers

Rules Coordinator

OTS-5285.2

AMENDATORY SECTION(Amending Order 99-03, filed 9/8/99, effective 10/9/99)

WAC 182-08-095   Waiver of coverage.   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.

[Statutory Authority: RCW 41.05.160. 99-19-029 (Order 99-03), 182-08-095, filed 9/8/99, effective 10/9/99; 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.]

(2) The following three examples describe typical situations of dual eligibility. These are not the only situations where dual eligibility may arise and are provided as illustrations only.

(a) A husband and wife who are both employed by PEBB-participating employers, such as state agencies, may enroll only in medical or dental as an employee and not also as a dependent. That is, the husband may enroll only under his employing agency and the wife may enroll only under her employing agency.

(b) A dependent child that is eligible for coverage under two or more parents or stepparents who are employed by PEBB-participating employers, may be enrolled as a dependent under the coverage of one parent or stepparent, but not more than one.

(c) An employee employed in an insurance-eligible position by more than one PEBB-participating employer may enroll only under one employer. The employee may choose to enroll in insurance under the employer that:

(i) Offers the most favorable cost-sharing arrangement; or

(ii) Employed the employee for the longer period of time.

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Washington State Code Reviser's Office