15-24-111

WSR 15-24-111

POLICY STATEMENT

HEALTH CARE AUTHORITY

(Public Employees Benefits Board)

[Filed December 1, 2015, 1:39 p.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, 2016. You can download the complete policy statements at www.hca.wa.gov/pebb/Pages/policy.aspx.

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 #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: Retiree deferral form exemption. 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 #31-1: Verifying dependent eligibility before enrollment. This policy clarifies which documents the PEBB program considers valid for dependent verification.

Policy #31-2: Use of premium surcharge help sheet and spousal plan calculator tools. This policy provides direction when a PEBB subscriber enrolled in PEBB medical, but not enrolled in Medicare Part A and Part B in which medicare is the primary payer, is determining if he or she must pay a premium surcharge for an enrolled spouse or registered domestic partner who elected not to enroll in his or her employer-based group medical insurance.

Policy #37-1: Certifying eligibility for an extended dependent child. This policy applies when a subscriber submits the required forms to enroll an extended dependent child in the subscriber's PEBB benefits.

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 #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 the 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).

The PEBB program is rescinding the following policy:

Policy #31-3: Attestation requirements for the Spouse or Registered Domestic Partner Coverage premium surcharge.

To receive a hard copy of the policy statements, contact Rob Parkman, 626 8th Avenue S.E., Olympia, WA 98501-2684, or [phone].