Change coverage

Changes you can make during open enrollment

Our annual open enrollment is held in the fall. To make any of the changes below, we must receive your request in Benefits 24/7 or the required forms no later than the last day of open enrollment. The change will become effective January 1 of the next year.

• Change medical, dental, or vision plans.
• Add dental or vision coverage.
• Enroll or remove eligible dependents.
• Defer your PEBB retiree insurance coverage.
• End your PEBB retiree insurance coverage.
• Enroll if you deferred in the past.
  You must provide proof of continuous enrollment in one or more qualifying medical coverages to return to a PEBB retiree health plan after a deferral. You can have a gap of 31 days or less between the date you defer your PEBB coverage and the start date of a qualified coverage, and between each qualified coverage. We encourage you to collect proof of coverage annually and keep a file to provide to the PEBB Program in the event you want to return in the future.

Changes you can make anytime

You can make some changes during the year without a special open enrollment event. Use Benefits 24/7 or submit the Retiree Change Form (form E) to report the change, unless otherwise noted.

• Change your or a dependent's tobacco use premium surcharge attestation. Use the PEBB Premium Surcharge Attestation Change form or log in to Benefits 24/7.
• Cancel or defer (postpone) your PEBB retiree insurance coverage.
• Remove a dependent from your PEBB retiree insurance coverage.
• Change your retiree term life insurance beneficiary information. Use the MetLife Beneficiary Designation form, or call MetLife at 1-866-548-7139.
• Apply for, cancel, or change auto and home insurance coverage.
• Manage your health savings account contribution or change your HSA beneficiary information. UMP members, call 1-844-351-6853 (TRS: 711). Kaiser Permanente members, call 1-877-873-8823 (TRS: 711).

Cancel your coverage

Use Benefits 24/7 or submit your request in writing:  

• Send us a secure message through HCA Support.
• Fax.
• Mail us a written request.

If you cancel all of your PEBB retiree health plan coverage, you cannot enroll again later unless you regain eligibility for PEBB retiree insurance coverage, for example, by returning to employment in a PEBB benefits-eligible position or for a SEBB Organization in which you are eligible for SEBB benefits. If you cancel coverage, any enrolled dependents’ coverage will be cancelled as well.

When does coverage end? 

Your health plan coverage will end on the last day of the month in which we receive your request (or a future date if you ask for one). PEBB retiree insurance coverage is for an entire month and must end as follows:

• When you or a dependent loses eligibility for PEBB retiree insurance coverage, coverage ends on the last day of the month in which eligibility ends.
• Coverage for you and your enrolled dependents ends on the last day of the month for which the monthly premium and applicable premium surcharges were paid. If you or a dependent are enrolled in a Medicare Advantage plan, cancellation will occur at the end of the month after the month your termination notice was sent.
• Coverage for you or an enrolled dependent ends if you don't respond to a request from the PEBB Program for information regarding Medicare Part A and Part B enrollment or an action required due to enrollment in Medicare Part D.

Exception 

If you are cancelling medical coverage and you or a covered dependent are enrolled in a Medicare Advantage with Part D plan, use Benefits 24/7 or submit the Medicare Plan Disenrollment Form (form D). PEBB retiree health plan coverage will end on the last day of the month when your Benefits 24/7 request or the Medicare Plan Disenrollment Form (form D) is received.

Change your address

There are several ways to notify us of your address change:

• Send us a secure message through HCA Support.
• Use the Retiree Change Form (form E).
• Fax.
• Mail us a written request.
• Call us.

When do changes take effect?

In most cases, the change will occur the first day of the month after the date of the event or the date we receive your forms, whichever is later. If that day is the first of the month, the enrollment change begins on that day.

Exceptions

• Medicare Advantage with part D plans. Start the first of the month after we receive your forms, per federal rules.
• Arrival of a child (a newborn, adopted child, or a child you are legally required to support ahead of adoption). PEBB benefits will start or end as follows:
  • A newborn child, PEBB health plan coverage will start on the date of birth.
  • A newly adopted child, PEBB health plan coverage will start on the date of placement or the date you assume legal responsibility for their support ahead of adoption, whichever is earlier.
  • Enrolling a spouse or SRDP because of a birth or adoption, PEBB health plan coverage will start the first day of the month in which the event occurs.
  • If the special open enrollment is due to a child becoming eligible as an extended dependent or a dependent child with a disability, PEBB health plan coverage will start the first day of the month following either the event date or the date we confirm their eligibility, whichever is later.