Date of Adoption: November 28, 2001.
Purpose: WAC 182-08-095 is revised by striking the words "and dependents." As a result, eligible PEBB active employees will have the ability to waive dental coverage for eligible dependents.
A new section WAC 182-08-125 is added. This section limits 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 service 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 for persons eligible for PEBB-sponsored health coverages. These changes were necessary to effectuate this eligibility change based on 2001 legislation and the vote at the August 7, 2001, PEBB board meeting, which eliminated "dual eligibility."
Citation of Existing Rules Affected by this Order: Amending WAC 182-08-095 and added new section WAC 182-08-125.
Statutory Authority for Adoption: RCW 41.05.160.
Other Authority: RCW 41.05.065.
Adopted under notice filed as WSR 01-21-143 on October 24, 2001.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 1, Amended 1, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 1, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making:
Pilot Rule Making:
or Other Alternative Rule Making:
Effective Date of Rule: Thirty-one days after filing.
November 29, 2001
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.
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
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.