WSR 21-13-101
PERMANENT RULES
HEALTH CARE AUTHORITY
(Public Employees Benefits Board)
[Admin #2021-01.01—Filed June 18, 2021, 3:07 p.m., effective January 1, 2022]
Effective Date of Rule: January 1, 2022.
Purpose: The purpose of this proposal is to amend and repeal rules to support the public employees benefits board (PEBB) program.
Implement PEBB policy resolution and make other technical amendments:
Repealed WAC 182-12-208 to implement policy resolution PEBB 2021-01 removing the retiree two-year dental enrollment requirement.
Amended WAC 182-12-250 to implement policy resolution PEBB 2021-01 removing the retiree two-year dental enrollment requirement and to clarify survivors' enrollment requirements when returning to a PEBB health plan following deferment.
Citation of Rules Affected by this Order: Repealing WAC 182-12-208; and amending WAC 182-12-250.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160.
Other Authority: Policy resolution PEBB 2021-01.
Adopted under notice filed as WSR 21-10-070 on May 3, 2021.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 1, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 1.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 0, Repealed 0.
Date Adopted: June 18, 2021.
Wendy Barcus
Rules Coordinator
OTS-3018.1
AMENDATORY SECTION(Amending WSR 20-16-062, filed 7/28/20, effective 1/1/21)
WAC 182-12-250Public employees benefits board (PEBB) insurance coverage eligibility for survivors of emergency service personnel killed in the line of duty.
Surviving spouses, state registered domestic partners, and dependent children of emergency service personnel who are killed in the line of duty are eligible to enroll or defer enrollment in public employees benefits board (PEBB) retiree insurance coverage.
(1) This section applies to the surviving spouse, the surviving state registered domestic partner, and dependent children of emergency service personnel "killed in the line of duty" as determined by the Washington state department of labor and industries.
(2) "Emergency service personnel" means law enforcement officers and firefighters as defined in RCW 41.26.030, members of the Washington state patrol retirement fund as defined in RCW 43.43.120, and reserve officers and firefighters as defined in RCW 41.24.010.
(3) "Surviving spouse, state registered domestic partner, and dependent children" means:
(a) A lawful spouse;
(b) An ex-spouse as defined in RCW 41.26.162;
(c) A state registered domestic partner as defined in RCW 26.60.020(1); and
(d) Children. The term "children" includes children of the emergency service worker up to age twenty-six. Children with disabilities as defined in RCW 41.26.030(6) are eligible at any age. "Children" is defined as:
(i) Biological children (including the emergency service worker's posthumous children);
(ii) Stepchildren or children of a state registered domestic partner;
(iii) Legally adopted children;
(iv) Children for whom the subscriber has assumed a legal obligation for total or partial support in anticipation of adoption of the child;
(v) Children specified in a court order or divorce decree; or
(vi) Children as defined in RCW 26.26A.100.
(4) Surviving spouses, state registered domestic partners, and children who are eligible for medicare must enroll in both Parts A and B of medicare.
Note:
For the exclusive purpose of medicare Part A as described in this subsection, "eligible" means the enrollee is eligible for medicare Part A without a monthly premium.
(5) The survivor (or agent acting on their behalf) must submit the required forms to the PEBB program to either enroll or defer enrollment in PEBB retiree insurance coverage as described in subsection (7) of this section. The forms must be received by the PEBB program no later than one hundred eighty days after the later of:
(a) The death of the emergency service worker;
(b) The date on the letter from the department of retirement systems or the board for volunteer firefighters and reserve officers that informs the survivor that they are determined to be an eligible survivor;
(c) The last day the surviving spouse, state registered domestic partner, or child was covered under any health plan through the emergency service worker's employer; or
(d) The last day the surviving spouse, state registered domestic partner, or child was covered under the Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage from the emergency service worker's employer.
(6) Survivors who do not choose to defer enrollment in PEBB retiree insurance coverage may choose among the following options for when their enrollment in a PEBB health plan will begin:
(a) June 1, 2006, for survivors whose required forms are received by the PEBB program no later than September 1, 2006;
(b) The first of the month that is not earlier than sixty days before the date that the PEBB program receives the required forms (for example, if the PEBB program receives the required forms on August 29th, the survivor may request health plan enrollment to begin on July 1st); or
(c) The first of the month after the date that the PEBB program receives the required forms.
Exception:
Enrollment in the PEBB program's medicare advantage or medicare advantage-prescription drug plan may not be retroactive. If the forms are received after the date enrollment in PEBB retiree insurance coverage is to begin, the survivor may not select a medicare advantage or medicare advantage-prescription drug plan until a special enrollment period as described in WAC 182-08-198(2).
For surviving spouses, state registered domestic partners, and children who enroll, monthly health plan premiums and applicable premium surcharges must be paid by the survivor as described in WAC 182-08-180 (1)(c) except as provided in RCW 41.26.510(5) and 43.43.285 (2)(b).
(7) Survivors must choose one of the following two options to maintain eligibility for PEBB retiree insurance coverage:
(a) Enroll in a PEBB health plan:
(i) Enroll in medical; or
(ii) Enroll in medical and dental.
(iii) ((Survivors enrolling in dental must stay enrolled for at least two years before dental can be dropped, unless they defer PEBB retiree insurance coverage as described in WAC 182-12-205, or drop dental as described in WAC 182-12-208(4).
(iv))) Dental only is not an option.
(b) Defer enrollment:
(i) Survivors may defer enrollment in PEBB retiree insurance coverage if continuously enrolled in qualifying coverage as described in WAC 182-12-205(3).
(ii) Survivors may enroll in a PEBB health plan as described in WAC 182-12-205(6) ((when they lose other coverage)). Survivors must provide evidence that they were continuously enrolled in one or more qualifying coverages as described in WAC 182-12-205 (3)(a) through (e) when enrolling in a PEBB health plan. ((The required form and evidence of continuous enrollment must be received by the PEBB program no later than sixty days after such coverage ends.))
Exception:
Enrollment in the PEBB program's medicare advantage or medicare advantage-prescription drug plan may not be retroactive so the required forms and evidence of continuous enrollment must be received by the PEBB program no later than the last day of the month prior to the month coverage ends. If the forms are received after the date enrollment in PEBB retiree insurance coverage is to begin, the survivor may not select a medicare advantage or medicare advantage-prescription drug plan until a special enrollment period as described in WAC 182-08-198(2).
(iii) PEBB health plan enrollment and premiums will begin the first day of the month following the day that the other coverage ended for eligible spouses and children who enroll.
(8) Survivors may change their health plan during the annual open enrollment. In addition to the annual open enrollment, survivors may change health plans as described in WAC 182-08-198.
(9) Survivors will lose their right to enroll in PEBB retiree insurance coverage if they:
(a) Do not apply to enroll or defer enrollment within the timelines as described in subsection (5) of this section; or
(b) Do not maintain continuous enrollment in other qualifying coverage during the deferral period, as described in subsection (7)(b)(i) of this section.
REPEALER
The following section of the Washington Administrative Code is repealed:
WAC 182-12-208
What are the requirements regarding enrollment in dental under public employees benefits board (PEBB) retiree insurance coverage?