Employer groups

Eligibility

Counties, municipalities, political subdivisions, employee organizations representing state civil service employees, and tribal governments are eligible to purchase employee benefits through the Public Employees Benefits Board (PEBB) Program per chapter RCW 41.05 and WAC 182-08.

PEBB Program group coverage is available only to entities and employees that perform governmental functions and are not controlled by private interests. PEBB Program group coverage is available to all employees, individual bargaining groups, or all nonrepresented employees of the group.

Your group may request inclusion of retirees covered under your current retiree health plan, subject to PEBB Program requirements outlined in WAC 182-08-237. Employees who retire after your group joins PEBB will be eligible for PEBB Program retiree coverage based on retiree eligibility rules. Coverage for retirees only is not available through the PEBB Program.

Eligibility criteria for employees are defined in WAC 182-12-114 and for dependents in WAC 182-12-260. The employer group may negotiate different eligibility criteria with HCA for their employees as described in RCW 41.05.065 (4). Requests must be submitted in writing and approved by HCA. Additional information regarding group eligibility is in WAC 182-12-111.

Participating counties, municipalities, political subdivisions and tribal governments will incur an employer group rate surcharge that will be applied to the monthly rate. For additional information about the employer group rate surcharge contact PEBB Outreach and Training at 1-800-700-1555.

Benefits

The PEBB Program provides a comprehensive insurance package that includes:

• Medical/vision
• Dental
• Life and accidental death and dismemberment (AD&D)
• Long-term disability

Optional coverage is available for auto and home insurance.

Your employees may select any PEBB Program health plan available in their county of residence.

Your counties, municipalities, subdivisions, and tribal government may purchase the full benefits package of medical/vision, dental, life and AD&D, and long-term disability, or may purchase only medical/vision. 

Costs

Employer groups

View the employer group monthly premiums. Rates for employer groups change in January.

Applicants may use the employer group projected monthly cost tool to estimate PEBB Program rates based on subscriber enrollment selections.

Startup fees

When a group joins the PEBB Program, they are assessed a start-up fee based on the number of eligible employees. The following table outlines these start-up fees.

How to apply

The application requirements for employer groups vary depending upon the number of employees in the group.

• Groups with fewer than 500 employees must submit a complete application at least 60 days before the requested coverage effective date.
• Groups with 500 or more employees but fewer than 5,000 employees must submit a complete application at least 90 days before the requested coverage effective date.
• Groups with 5,000 or more employees must submit a complete application at least 120 days before the requested coverage effective date.

Deadlines

• Application submission deadlines for 2024.

All groups must provide the following:

1. A letter of application that includes:
   1. A reference to the group’s authorizing statute;
   2. A description of the organizational structure and a description of the employee bargaining unit or group of nonrepresented employees for which the group is applying;
   3. Tax ID number; and
   4. A statement of whether the group is requesting medical, dental, life and AD&D, and long-term disability insurance or medical/vision only. 
2. A resolution from the group’s governing body authorizing the purchase of PEBB insurance coverage. Sample resolution
3. A signed governmental function attestation document that attests to the fact that employees for whom the group is applying are governmental employees whose services are substantially all in the performance of essential governmental functions. Sample attestation
4. A member level census file for all employees for whom the group is applying. The file must be provided in the format required and contain the following: demographic data, by member, with each member classified as employee, spouse or state-registered domestic partner, or child. Member Level Census Data

   If the application is for a subset of the group’s employees (e.g., bargaining unit), the group must provide a member level census data file for all employees eligible under the current health plans who are not included in the census file above. This includes retired employees participating under the group’s current health plans. Member Level Census Data

5. Historical claims and cost information that includes:
   1. Large claims history for 24 months by quarter that excludes the most recent 3 months,
   2. Ongoing large claims management report for the most recent quarter provided in the large claims history, and
   3. A summary of historical plan costs.

In addition, groups with 5,000 or more employees and organizations representing state civil service employees and the Washington Health Benefit Exchange, regardless of the number of employees, must also provide the following:

• An actuarial evaluation of the group provided by an actuary designated by the PEBB Program. The group must pay for the cost of the evaluation.
• An executive summary of benefits, a summary of benefits and certificate of coverage.

For additional information, contact PEBB Outreach and Training at 1-800-700-1555.

Send your application to:

Jesse Paulsboe
PEBB Program Outreach and Training
Health Care Authority
PO Box 42684
Olympia, WA 98504-2684
Email: Jesse Paulsboe

Review process

HCA will review your application for compliance with HCA terms and conditions of participation. Groups with fewer than 5,000 employees will be notified by the PEBB Program in writing upon acceptance or denial of your application. Your application may be denied if your group fails to provide the required information and documents described here.

Groups with 5,000 employees or more and employee organizations representing state civil service employees and the Washington Health Benefit Exchange, regardless of the number of employees, will have their application approved or denied through the evaluation criteria described in WAC 182-08-240.

You will be notified by the PEBB Program in writing upon acceptance or denial of your application. If the application is denied, you may reapply for participation at any time. In addition, you may file an appeal.

What you must do when your group is enrolled

The PEBB Program bills groups monthly. You will receive an invoice around the 25th of each month before the month of coverage. Payment in-full is due by the 20th of the month of coverage. For example, around May 25 an invoice will be sent for June coverage. Payment in-full for June coverage is due by June 20.

You are expected to provide your own PEBB Program account maintenance. Groups with more than 75 employees must manage entering account information into the PEBB Program insurance system (PAY1). The PEBB Program provides training.

Cancelling participation with the PEBB Program

Once your group joins the PEBB Program, participation is required for at least one full year and may only terminate at the end of a plan year, which the PEBB Program has identified as the end of December for employer groups. HCA will consider requests for mid-year terminations that meet criteria in Policy #90-1.

Employer groups that cancel their participation with the PEBB Program assume responsibility for the continued insurance of any employees on COBRA or continuation coverage and must provide notice to them 45 days prior to the employer group's date of termination. Retirees are no longer eligible for PEBB retiree insurance coverage as of the last day of the contract and may continue enrollment as described in WAC 182-12-5120.

Employer groups that enter into a contractual agreement on or after May 4, 2023, and whose contractual agreement is subsequently terminated, must make a one-time payment to HCA for each of their retired employees who continue enrollment as described in WAC WAC 182-12-5120. The one-time payment will be determined by HCA as described in the contract and RCW 41.05.083. 

After the group cancels participation, enrollment data for Form 1095 for the retirees that choose to continue coverage as described in WAC 182-12-5120, and who enroll in Uniform Medical Plan coverage, will continue to be sent for reporting purposes.

Employer groups defined

The PEBB Program defines an employer group to include counties, municipalities, political subdivisions, the Washington health benefit exchange, tribal governments, and employee organizations representing state civil service employees. The full definition is in WAC 182-08-015.