WSR 14-12-067
(Public Employees Benefits Board)
[Admin # 2014-02—Filed June 2, 2014, 10:42 a.m.]
Subject of Possible Rule Making: Enrollment, eligibility, and appeal rules in chapters 182-08, 182-12, and 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: 1. The health care authority (HCA) will consider amendments and new rules to accomplish the following:
Clarify requirements for submitting a medical flexible spending arrangement (FSA) or dependent care assistance program (DCAP) enrollment form.
Clarify which employing agency is responsible for payment of the employer contribution when an employee transfers between agencies.
Clearly separate individuals from entities in the rule that describes individuals and entities who are not eligible for participation in public employees benefits board (PEBB) benefits.
Add an exception in the rule that prohibits dual enrollment in a PEBB health plan to address instances where a dependent is dual eligible for a partial month.
Replace the phrase "comprehensive group medical coverage" with "employer-based group health insurance" throughout.
Clarify that the employer contribution toward PEBB benefits ends on the last day of the month when an individual ceases to be eligible.
Amend the retiree rule to address the gap in coverage that can occur when COBRA coverage ends early due to medicare eligibility.
Amend the retiree dental rule to allow early termination of dental if the retiree becomes eligible for employer dental.
Amend the retiree deferral rules to provide clarity regarding the effective date of a deferral.
Clarify that a retiree's dependent may not enroll in dental coverage only.
Amend the rule that authorizes employees to enroll in PEBB retiree insurance in the case of a retroactive disability retirement awarded by DRS or a higher education authority so it is clear that the retirement must be due to disability.
Clarify that references to "registered domestic partner" includes both a state registered domestic partner and a domestic partner who was qualified under PEBB eligibility criteria as a domestic partner before January 1, 2010, and was continuously enrolled under the subscriber in a PEBB health plan or life insurance.
Clarify the notice required when a dependent is no longer eligible for PEBB benefits.
Amend the special open enrollment rules to account for dependents that move from the United States to outside the United States.
Clarify when coverage begins for a child enrolled in coverage based on a National Medical Support Notice or court order.
Amend the surcharge rules to account for issues identified during the implementation phase.
Amend the wellness rules to account for issues identified during the implementation phase.
Provide additional definitions of terms used in the rules.
Amend the appeal rules to address appeals regarding a denial of FSA or DCAP enrollment.
Clarify all affected rules to appropriately include "charter schools" with school districts and educational service districts.
Add general hearing rules and procedures that apply to an administrative hearing of a PEBB appeal committee decision.
Amend all affected rules to require that forms and paperwork must be received within the stated timelines instead of submitted or sent within the timeline.
2. HCA will conduct a full review of PEBB 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 by contacting HCA, P.O. Box 42684, Olympia, WA 98504-2684, fax (360) 586-9727, TTY 1-800-848-5429, e-mail, Individuals wishing to receive PEBB rule-making notices are encouraged to join the PEBB-RULE-MAKING-NOTICE listserv available by following this path 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 the address above.
June 2, 2014
Kevin M. Sullivan
Rules Coordinator