WSR 16-24-083
(Public Employees Benefits Board)
[Filed December 7, 2016, 8:32 a.m.]
Notice of Administrative Policy Statements
The following is a list of administrative policies issued by the public employees benefits board (PEBB) program. These policies are effective January 1, 2017. You can download the complete policy statements at
Policy 11-3: Correcting employing agency enrollment errors. This policy clarifies the requirements placed on an employing agency when the employing agency corrects its enrollment errors as described in WAC 182-08-187.
Policy 15-1: Determining eligibility for seasonal employees and maintenance of employer contribution through the off-season. This policy clarifies seasonal employee eligibility for PEBB benefits and the employer contribution.
Policy 17-1: Determining faculty eligibility for summer/short class sessions. To clarify a higher education institution's role in defining faculty for the purposes of insurance benefits.
Policy 17-2: Determining faculty eligibility after a layoff. Applying the criteria for maintaining the employer contribution toward insurance coverage for faculty following a layoff.
Policy 17-3: Determining faculty eligibility for off-quarter/semester or for decreases in workload. To clarify when a faculty member qualifies for the employer contribution toward insurance coverage during an off-quarter/semester or when there is a decrease in workload.
Policy 19-1: Termination due to loss of eligibility. This policy applies whenever coverage for a subscriber or a subscriber's dependent is terminated due to loss of eligibility.
Addendum 19-1A: Termination due to loss of eligibility: Employee.
Addendum 19-1B: Termination due to loss of eligibility: Self-pay subscriber.
Policy 21-1: Exemption from retiree deferral form. This policy exempts certain retirees from the procedural requirement of completing a deferral form in WAC 182-12-171 (1)(a) and 182-12-205(2).
Policy 26-1: Administering PEBB insurance in coordination with Medicare Part D. To administer PEBB retiree medical plan enrollment in order to participate in the employer incentive program established in section 1860D-22 of the Medicare Prescription Drug Improvement and Modernization Act of 2003.
Policy 31-1: Verifying dependent eligibility before enrollment. This policy clarifies which documents the PEBB program considers valid for dependent verification.
Policy 45-2: Special open enrollment (SOE). This policy applies whenever a subscriber requests an enrollment change or election change outside of the PEBB annual open enrollment.
Addendum 45-2A: Special open enrollment (SOE) matrix: Summary of permitted election changes.
Policy 90-1: Allowable mid-year employer group terminations. This policy clarifies when employer group participation may terminate mid-year.
Policy 91-1: Requesting a reasonable alternative for completing wellness incentive program requirements or avoiding the tobacco use premium surcharge. This policy applies when a subscriber who is eligible to participate in PEBB wellness incentive program is seeking a reasonable alternative to a wellness incentive program requirement in order to receive a wellness incentive as described in WAC 182-12-300. This policy also applies when an enrollee on a PEBB medical plan is seeking a reasonable alternative so that a subscriber can avoid paying the tobacco premium surcharge as described in WAC 182-08-185 (1)(c).
Policy 93-1: PEBB program premium payment and premium surcharge collection and write-off. This policy outlines the criteria used by PEBB insurance accounting to determine when a premium payment or premium surcharge owed on a subscriber's account will be deemed uncollectable and subsequently written off.
This policy does not apply to state agencies, employer groups, charter schools, or collection of a claim or benefit by an HCA contracted plan or third party administrator.
Policy 93-2: PEBB program payment plans. This policy describes the process through which a subscriber or his or her legal representative may request a payment plan and the criteria the PEBB program will use when authorizing a payment plan.
To receive a hard copy of the policy statements, contact Rob Parkman, 626 8th Avenue S.E., Olympia, WA 98501-2684 or (360) 725-0883.