Retiree eligibility

Eligibility requirements

For legal definitions, refer to Related laws and rules at the bottom of this page.

Employment requirements

Retiring or separating employees of a:

• State agency.
• State higher-education institution.
• PEBB- or SEBB-participating employer group.
• Washington school district, educational service district, or charter school.

Surviving dependents and elected or full-time appointed officials requirements

• A surviving dependent.
• An elected or full-time appointed official of the legislative or executive branch of state government who leaves public office.

Disability requirements

• An employee determined to be retroactively eligible for disability retirement.

Medicare requirements

If you or a dependent are eligible for Medicare, the eligible person must enroll (and stay enrolled) in Medicare Part A and Part B.

PEBB retiree insurance coverage works in coordination with Medicare; you pay your Medicare Part B premium directly to Medicare.

Returning to work requirements

Once enrolled in PEBB retiree insurance coverage, if you become eligible for the employer contribution for PEBB or SEBB benefits by working for a PEBB employer, SEBB organization, or SEBB employer group, you cannot waive the employer coverage in order to remain in PEBB retiree insurance coverage even if you are enrolled in Medicare. PEBB retiree insurance coverage is automatically deferred. You do not need to defer using Benefits 24/7 or submit a form.

If your dependent is enrolled and becomes eligible for the employer contribution, they will be automatically disenrolled from PEBB retiree insurance coverage.

Retirement plan requirements

You must be a vested member and meet the eligibility criteria to retire from a Washington State-sponsored retirement plan when your employer-paid, COBRA, or continuation coverage ends

Washington State-sponsored retirement plans include:

• Public Employees' Retirement System (PERS) 1, 2, or 3
• Public Safety Employees' Retirement System (PSERS) 2
• Teachers Retirement System (TRS) 1, 2, or 3
• Washington Higher Education Retirement Plan (for example, TIAA)
• School Employees' Retirement System (SERS) 2 and 3
• Law Enforcement Officers' and Fire Fighters' Retirement System (LEOFF) 1 or 2
• Washington State Patrol Retirement System (WSPRS) 1 or 2
• State Judges/Judicial Retirement System
• Civil Service Retirement System and Federal Employees' Retirement System (for Washington State University Extension employees covered under PEBB benefits at the time of retirement).

• Different rules apply if you are an elected or full-time appointed official or an employee of an employer group that does not participate in a Washington State-sponsored retirement plan. (Refer to Related laws and rules.)

You must begin to receive a monthly retirement play payment no later than the first month following your employer-paid, COBRA, or continuation coverage ending, unless one of the following exceptions apply

• If you receive a lump sum payment, you are only eligible for PEBB retiree insurance coverage if DRS offered you the choice between a lump sum actuarially equivalent payment and an ongoing monthly payment.
• If you are retiring or separating under PERS Plan 2, TRS Plan 2, or SERS Plan 2, and you separated from employment on or after January 1, 2024, and you are at least age 55 and have at least 20 years of service.
• If you are retiring or separating under PERS Plan 3, TRS Plan 3, or SERS Plan 3, and you are at least age 55 and have at least 10 years of service.
• If you are an employee retiring under a Washington State Higher Education Retirement Plan (such as TIAA) and meet your plan's retirement eligibility criteria or you are at least age 55 with 10 years of state service.
• If you are a retiring employee from a PEBB employer group who is eligible to retire under a retirement plan sponsored by an employer group or tribal government, and your employer does not participate in a Washington State-sponsored retirement plan. However, you must meet the same age and years of service requirements as if they had been employed as a member of PERS Plan 1 (if your date of hire with your employer group or tribal government was before October 1, 1977) or Plan 2 (if your date of hire with your employer group or tribal government was on or after October 1, 1977).
• If you are a retiring school employee from a SEBB employer group who is eligible to retire under a retirement plan sponsored by an employer group and your employer does not participate in a Washington State-sponsored retirement plan. However, you must meet the same age and years of service requirements as members of TRS Plan 1 (if your date of hire with your employer group was before October 1, 1977) or Plan 2 (if your date of hire was on or after October 1, 1977).
• If you are an elected or a full-time appointed official of the legislative or executive branch of state government, or a surviving dependent of such an official.
• If you are a survivor of an emergency service person killed in the line of duty, or a surviving dependent who loses eligibility because of the death of an eligible retiree.

How is eligibility determined?

The PEBB Program determines eligibility once you submit the Retiree Election Form (form A) and supporting documents. We use the eligibility rules and requirements defined by Washington Administrative Codes (WACs). Refer to Related laws and rules at the bottom of this page.)

There are two types of requirements

You must meet both.

• Procedural (enrollment/deferment) requirements = tasks you must complete within a certain timeframe
• Eligibility requirements = criteria you must meet

Eligibility as a retiree and a dependent

You cannot enroll in medical, dental, or vision coverage under two PEBB accounts. If eligible, you cannot waive PEBB employee coverage for PEBB retiree coverage. If you and your spouse or state-registered domestic partner (SRDP) are both eligible, you will need to decide which of you will enroll and cover the other as a dependent. You may also enroll separately if you and your spouse or SRDP are both eligible.

Tasks you must do and criteria you must meet

What you need to do – and the criteria you must meet – depends on your situation and whether you are enrolling in, or deferring enrollment in, PEBB retiree insurance coverage.

For details visit:

• New retiree enrollment
• Defer coverage

Can I lose eligibility?

Yes. There are a number of reasons you might lose eligibility, such as:

• You miss a deadline for enrolling or deferring.
• You no longer meet the criteria to enroll or defer.
• You defer coverage and are unable to provide proof of other qualifying medical coverage when you wish to enroll after deferral.
• You choose to cancel coverage.
• You don't pay your monthly premiums and applicable premium surcharges timely.
• You fail to respond to a request from the PEBB Program for information about Medicare Part A and Part B for you or a dependent, or an action required due to enrolling in Medicare Part D plan, or another Medicare Advantage or Medicare Advantage Prescription Drug (MAPD) plan.
• You must be disenrolled from an MAPD or Medicare Part D plan as required by federal law, due to permanently living in a location outside of the U.S. If this is the case, you may defer enrollment in PEBB retiree insurance coverage.

If I lose eligibility, can I become eligible again?

Yes, you can become eligible again by returning to employment with a PEBB employing agency SEBB organization, or SEBB employer group in a position where you are eligible for PEBB or SEBB benefits and, when you leave employment, meet the procedural and eligibility requirements.

Related laws and rules

Washington Administrative Codes (WAC) are the official rules used for PEBB Program eligibility and deferral.

Eligibility-related

For employees

• WAC 182-12-171: When is a retiring employee or a retiring school employee eligible to enroll in public employees benefits board (PEBB) retiree insurance coverage?
• WAC 182-12-211: May an employee or a school employee who is determined to be retroactively eligible for disability retirement enroll or defer enrollment in public employees benefits board (PEBB) retiree insurance coverage?

For elected or full-time appointed officials

• WAC 182-12-180: When is an elected and full-time appointed official of the legislative and executive branch of state government, or their survivor eligible to continue enrollment in public employees benefits board (PEBB) retiree insurance coverage?

For survivors

• WAC 182-12-180: When is an elected and full-time appointed official of the legislative and executive branch of state government, or their survivor eligible to continue enrollment in public employees benefits board (PEBB) retiree insurance coverage?
• WAC 182-12-250: Public employees benefits board (PEBB) insurance coverage eligibility for survivors of emergency service personnel killed in the line of duty.
• WAC 182-12-265: What options for continuing health plan enrollment are available to a surviving spouse, state registered domestic partner, or child, if an employee, a school employee, or a retiree dies?

Deferral-related

• WAC 182-12-200: May a retiring employee, a retiring school employee, or a retiree enrolled as a dependent in a health plan sponsored by public employees benefits board (PEBB) or school employees benefits board (SEBB) defer enrollment under PEBB retiree insurance coverage?
• WAC 182-12-205: May a retiree or a survivor defer enrollment or voluntarily terminate enrollment under public employees benefits board (PEBB) retiree insurance coverage?