Section 182-12-207. When can a retiree or eligible dependent's public employees benefits board (PEBB) insurance coverage be canceled by the health care authority (HCA)?

A retiree or eligible dependent's insurance coverage can be canceled by HCA for the following reasons:

(1) Failure to comply with the PEBB program's procedural requirements, including failure to provide information or documentation requested by the due date in written requests from the PEBB program;

(2) Knowingly providing false information;

(3) Failure to pay the premium when due or an underpayment of premium;

(4) Misconduct. If a retiree's insurance coverage is canceled for misconduct, insurance coverage will not be reinstated at a later date. Examples of such termination include, but are not limited to the following:

(a) Fraud, intentional misrepresentation or withholding of information the subscriber knew or should have known was material or necessary to accurately determine eligibility or the correct premium; or

(b) Abusive or threatening conduct repeatedly directed to an HCA employee, a health plan or other HCA contracted vendor providing insurance coverage on behalf of the HCA, its employees, or other persons.

If a retiree's insurance coverage is canceled by HCA for the above reasons, insurance coverage for all of the retiree's eligible dependents is also canceled.

[Statutory Authority: RCW 41.05.160. WSR 09-23-102 (Order 09-02), § 182-12-207, filed 11/17/09, effective 1/1/10; WSR 07-20-129 (Order 07-01), § 182-12-207, filed 10/3/07, effective 11/3/07.]

(Effective January 1, 2017.)

WAC 182-12-207

When can a retiree or eligible dependent's public employees benefits board (PEBB) insurance coverage be canceled by the health care authority (HCA)?

A retiree or eligible dependent's public employees benefits board (PEBB) insurance coverage can be terminated by the health care authority (HCA) for the following reasons:

(1) Failure to comply with the PEBB program's procedural requirements, including failure to provide information or documentation requested by the due date in written requests from the PEBB program;

(2) Knowingly providing false information;

(3) Failure to pay the monthly premium or premium surcharge when due as described in WAC 182-08-180 (1)(b);

(4) Misconduct. If a retiree's PEBB insurance coverage is terminated for misconduct, PEBB insurance coverage will not be reinstated at a later date. Examples of such termination include, but are not limited to the following:

(a) Fraud, intentional misrepresentation or withholding of information the subscriber knew or should have known was material or necessary to accurately determine eligibility or the correct premium; or

(b) Abusive or threatening conduct repeatedly directed to an HCA employee, a health plan or other HCA contracted vendor providing insurance coverage on behalf of the HCA, its employees, or other persons.

If a retiree's PEBB insurance coverage is terminated by HCA for the above reasons, PEBB insurance coverage for all of the retiree's eligible dependents is also terminated.

[Statutory Authority: RCW 41.05.021, 41.05.160, 2016 c 67, and PEBB policy resolutions. WSR 16-20-080, § 182-12-207, filed 10/4/16, effective 1/1/17. Statutory Authority: RCW 41.05.160. WSR 09-23-102 (Order 09-02), § 182-12-207, filed 11/17/09, effective 1/1/10; WSR 07-20-129 (Order 07-01), § 182-12-207, filed 10/3/07, effective 11/3/07.]

RCW 41.05.160. WSR 09-23-102 (Order 09-02), § 182-12-207, filed 11/17/09, effective 1/1/10; WSR 07-20-129 (Order 07-01), § 182-12-207, filed 10/3/07, effective 11/3/07.] [Statutory Authority: RCW 41.05.021, 41.05.160, 2016 c 67, and PEBB policy resolutions. WSR 16-20-080, § 182-12-207, filed 10/4/16, effective 1/1/17. Statutory Authority: RCW 41.05.160. WSR 09-23-102 (Order 09-02), § 182-12-207, filed 11/17/09, effective 1/1/10; WSR 07-20-129 (Order 07-01), § 182-12-207, filed 10/3/07, effective 11/3/07.