PEBB rules and policies
The PEBB Program follows the rules in Washington Administrative Code (WAC). Our administrative policies describe how we implement a law or rule affecting participation in PEBB benefits.
On this page
Stay up-to-date with PEBB Program rule making and policy activity
PEBB Program law
You can find the PEBB Program's existing law in chapter 41.05 of the Revised Code of Washington (RCW).
PEBB Program rules
The PEBB Program follows the rules in Washington Administrative Code (WAC) chapters:
Below are links to the detailed rules for circumstances most common to employees, retirees, and dependents:
- Eligible and ineligible employees
- When are retiring employees eligible to enroll in retiree insurance?
- Who are eligible dependents?
- When must newly eligible employees select PEBB benefits and complete enrollment forms?
- Is dual enrollment in PEBB and SEBB prohibited?
- When may an employee waive enrollment in PEBB medical and when they enroll in PEBB medical after having waived enrollment?
- May a retiree or a survivor defer enrollment or voluntarily terminate enrollment under PEBB retiree insurance coverage?
- When may subscribers enroll or remove eligible dependents?
- When may subscribers change health plans?
- PEBB appeals rules
To find a specific WAC section look under chapters 182-08, 182-12, or 182-16.
PEBB Program policies
The PEBB Program's administrative policies describe how we implement a law or rule affecting participation in PEBB benefits. The statements made in these documents reflect our interpretations of the eligibility and enrollment rules.
Employee eligibility and enrollment
| Number | Title | Effective date |
|---|---|---|
| 11-1 |
Providing a notice to an employee and a state agency |
|
| 11-3 |
Correcting employing agency and contracted vendor enrollment errors |
|
| 15-1 | Determining eligibility for a seasonal employee and maintenance of employer contribution through the off-season | |
| 17-1 | Determining faculty eligibility for summer/short class sessions | |
| 17-2 | Determining faculty eligibility after a layoff | |
| 17-3 | Determining faculty eligibility for off-quarter/semester or for decreases in workload | |
| 19-1 | Termination due to loss of eligibility or enrollment error | |
| 19-1A | Addendum - Termination due to loss of eligibility or enrollment error: Employee | |
| 19-1B | Addendum - Termination due to loss of eligibility or nonpayment: Self-pay subscriber |
Retiree eligibility and enrollment
| Number | Title | Effective date |
|---|---|---|
| 21-1 | Exemption from the retiree deferral form requirement | |
| 26-1 | Administering PEBB retiree medical plan enrollment in coordination with Medicare Part D |
Dependent eligibility and enrollment
| Number | Title | Effective date |
|---|---|---|
| 31-1 | Verifying dependent eligibility before enrollment | |
| 31-2 | Use of the PEBB Spousal Plan Calculator | |
| 33-1 | Verifying legal union's residency status | |
| 36-1 | Certifying eligibility for a dependent child with a disability who is age 26 or older | |
| 37-1 | Certifying eligibility for an extended dependent child |
Special open enrollment
| Number | Title | Effective date |
|---|---|---|
| 45-2 | Special Open Enrollment (SOE) | |
| 45-2A | Addendum - Special open enrollment (SOE) matrix: Summary of permitted election changes |
Reinstatement, tolling, and continuation coverage
|
Number |
Title | Effective date |
|---|---|---|
|
56-1 |
Continuation coverage and retiree insurance coverage reinstatement for subscribers with mental or physical impairment or incapacitation |
|
| 56-2 | Election period tolling for applicants with mental impairment or physical incapacitation |
Appeals
|
Number |
Title | Effective date |
|---|---|---|
| 60-1 | Required appeals related documents when the PEBB Program conducts a brief adjudicative proceeding |
Administrative - permanent
| Number | Title | Effective date |
|---|---|---|
| 90-1 | Allowable mid-year employer group terminations for an employer group or board members of school districts and educational service districts | |
| 90-2 |
What authority do employer groups or board of directors for school districts and educational service districts need before contracting with the Health Care Authority (HCA) for participation in Public Employees Benefits Board (PEBB) for insurance coverage? |
|
| 90-3 |
Determining if an employer group or board of directors for school districts and educational service districts requesting eligibility criteria different from Public Employees Benefits Board (PEBB) Program rules shall be approved |
|
| 91-1 | Requesting a reasonable alternative for completing wellness incentive program requirements or avoiding the tobacco use premium surcharge | |
| 91-2 | Tobacco as it relates to religious or ceremonial use | |
| 91-3 | Washington Wellness worksite designation program incentive requirements | |
| 93-2 |
PEBB Program payment plans for continuation coverage and retiree accounts |
|
| 94-1 | Accessing PEBB Program salary reduction plan document | |
| 94-2 | Accessing PEBB Program wellness plan document | |
| 94-3 | Subscriber mistake - Factor test |
Proposed policies
There are no proposed policies at this time.
Rescinded or superseded policies
The policies listed below are rescinded. If you have any questions, please contact the PEBB Policy and Rules team at the address at the bottom of this page.
| Number | Title | Policy effective date |
|---|---|---|
| 11-1 |
Providing notifications to employees and employers |
|
| 11-3 |
Correcting employing agency enrollment errors |
1/1/2022 |
| 15-1 | Determining eligibility for seasonal employees and maintenance of employer contribution through the off-season |
1/1/2020 |
| 17-1 | Determining faculty eligibility for summer/short class sessions | |
| 17-2 | Determining faculty eligibility after a layoff |
1/1/2023 |
| 17-3 | Determining faculty eligibility for off-quarter/semester or for decreases in workload | |
| 19-1 | Termination due to loss of eligibility |
1/1/2023 |
| 19-1A | Addendum - Termination due to loss of eligibility: Employee |
1/1/2023 |
| 19-1B | Addendum - Termination due to loss of eligibility: Self-pay subscriber |
1/1/2023 |
| 21-1 | Exemption from retiree deferral form |
1/1/2023 |
| 26-1 | Administering PEBB insurance in coordination with Medicare Part D |
1/1/2023 |
| 31-1 | Verifying dependent eligibility before enrollment |
1/1/2023 |
| 31-2 |
Use of premium surcharge tools |
1/1/2023 |
| 33-1 | Verifying Legal Union's Residency Status | 1/1/2021 1/1/2020 1/1/2019 1/1/2018 4/26/2014 |
| 36-1 | Certifying eligibility for a dependent child with a disability who is age 26 or older |
1/1/2023 |
| 37-1 | Certifying eligibility for an extended dependent child |
1/1/2022 |
| 45-2 | Special Open Enrollment (SOE) |
1/1/2023 |
| 45-2A | Addendum - Special open enrollment (SOE) matrix: Summary of permitted election changes |
1/1/2023 |
| 56-1 |
Continuation Coverage and retiree insurance coverage reinstatement for subscribers with mental impairment or physical incapacitation |
1/1/2023 1/1/2022 1/1/2021 1/1/2020 1/1/2019 1/1/2018 |
| 56-2 |
Continuation Coverage and retiree insurance coverage election period tolling for applicants with mental impairment or physical incapacitation |
1/1/2023 1/1/2022 1/1/2021 1/1/2020 1/1/2018 |
| 60-1 | Required appeals related documents when the PEBB Program is hearing an appeal | 1/1/2020 1/1/2019 1/1/2018 |
| 90-1 | Allowable mid-year employer group terminations | |
| 90-2 | What authority to employer groups or charter schools need before contracting with the Health Care Authority (HCA) for participation in Public Employees Benefits Board (PEBB) for insurance coverage? | 1/1/2023 1/1/2021 1/1/2020 1/1/2018 |
| 90-3 | Determining if an employer group or charter school requesting eligibility standards different from Public Employees Benefits Board (PEBB) program rules shall be approved | 1/1/2023 1/1/2021 1/1/2020 1/1/2018 |
| 91-1 | Requesting a reasonable alternative for completing wellness incentive program requirements or avoiding the tobacco use premium surcharge |
1/1/2023 |
| 91-2 | Tobacco as it relates to religious or ceremonial use | 1/1/2023 1/1/2022 1/1/2020 1/1/2018 4/26/2014 |
| 91-3 | Washington Wellness worksite designation program incentive requirements | 1/1/2023 1/1/2022 1/1/2021 1/1/2020 1/1/2019 1/1/2018 |
| 93-2 | PEBB Program payment plans | 1/1/2021 1/1/2020 1/1/2018 |
| 94-1 | Accessing PEBB Program salary reduction plan document | 1/1/2023 1/1/2020 |
| 94-2 | Accessing PEBB Program wellness plan document | 1/1/2023 1/1/2020 |
| 94-3 | Subscriber mistake - Factor test | 1/1/2023 |
PEBB Program salary reduction plan
PEBB wellness plan
Contact
Mail:
Washington State Health Care Authority
PEBB Policy, Rules, and Compliance
PO Box 42684
Olympia, WA 98504-2684