WSR 15-10-080
(Public Employees Benefits Board)
[Admin 2015-01—Filed May 4, 2015, 1:10 p.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 41.05.021, 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 implement the following:
Clarify whether blind vendors have a sixty day notification requirement after a loss of group health or health insurance under HIPAA.
Clarify what "employer-based group medical insurance," "pay status," and "employee" means.
Clarify that new employees must either "enroll or waive" coverage within thirty-one days of eligibility.
Clarify within WAC 182-12-205 what conditions a retiring employee must meet in order to defer coverage, the timeline to defer retiree health plan coverage for both new and existing retirees, and when coverage ends for retiring employees who are deferring coverage.
Clarify termination for nonpayment within WAC 182-12-270, termination dates on self-pay accounts within WAC 182-12-146 and 182-12-148, and add termination language for retiree insurance self-pay accounts within WAC 182-12-208.
Amend the definition of "PEBB program" to remove the reference to "disabled employees."
Amending WAC 182-12-171 to account for retiring employee issues.
Clarify within WAC 182-12-123 the notification process between employers who employ the same employee and need to change who is paying the employer contribution.
Clarify the term "appointed officials" in WAC 182-12-114.
Amend WAC 182-12-131 to ensure coverage of RCW 41.05.065 (4)(c)(i) and to ensure references to WAC 182-12-114 are correct.
Clarify within WAC 182-08-235 that the employer group actuarial evaluation will be conducted by a public employees benefits board (PEBB) program designated actuary.
Clarify within WAC 182-16-073 what the PEBB program's rescheduling and continuance processes are.
Amend WAC 182-08-245 (1)(e) to replace the words "health plans" with "insurance coverages."
Amend WAC 182-08-240 to include a timeframe, for all group sizes, on how long an employer group evaluation is valid and that like populations will be evaluated against each other during the application process.
Amend WAC 182-08-185 to account for surcharge changes and issues.
Amend WAC 182-12-260(3) so it says that coverage for children ends on the last day of the month in which they turn twenty-six years old.
Amend WAC 182-08-187 to account for additional error correction issues that have been identified.
Amend WAC 182-08-196 to address unintended gaps in coverage.
Amend WAC 182-12-211 to include the ability to "defer" and that the references to WAC 182-12-171 are correct.
Clarify within WAC 182-12-262 (2)(c) when coverage ends for dependents.
Amend WAC 182-12-133 and 182-12-146 to include deadlines for COBRA/LWOP continuation coverage that mirror those requirements for COBRA.
Amend WAC 182-12-207 to add specific language regarding termination for nonpayment.
Amend WAC 182-12-200 to integrate provisions of Policy 21-1 that deal with retiree deferral form exemptions.
Amend WAC 182-16-036(1) so that it also includes eligibility for benefits and add the process flow for flexible spending arrangement appeals.
Amend WAC 182-16-040 to determine what must be included versus what may be included in a notice of appeal.
Amend WAC 182-12-260 to state the PEBB program requires dependent verification documents.
Amend WAC 182-16-062 to limit the HCA director's delegated powers to the office of administrative hearings.
Amend WAC 182-12-263 to remove "court orders."
Amend WAC 182-08-199 (3)(c)(vi) to update the Internal Revenue Service references.
Amend WAC 182-12-123 to clarify that eligibility as an employee supersedes eligibility as a dependent in most situations.
(2) HCA will conduct a full review of PEBB program rules in these chapters and make changes as necessary to provide technical corrections, implement legislation, implement PEBB policy, implement an accountable care program, and to comply with federal or state regulations.
Process for Developing New Rule: HCA welcomes the public to take part in developing this rule. If interested, contact the person identified below to receive an early rule draft to review. After the early review, HCA will send a notice of proposed rule making (CR-102) to everyone receiving this notice and 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. 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 the Health Care Authority, P.O. Box 42684, Olympia, WA 98504-2684, fax (360) 586-9727, TTY 1-800-848-5429, e-mail
May 4, 2015
Jason R. P. Crabbe
Rules Coordinator