Am I eligible?

What continuation coverage options are available?

The PEBB Program offers two types of continuation coverage.

PEBB Continuation Coverage (COBRA)

A temporary extension of PEBB health plan coverage available to PEBB members who are qualified beneficiaries under federal Consolidated Omnibus Budget Reconciliation Act (COBRA) rules. Coverage is also available to a retiree, their spouse or children, or other eligible subscribers who lose eligibility.

The Health Care Authority (HCA) also extends PEBB Continuation Coverage (COBRA) to state-registered domestic partners and their children. Coverage may be temporarily extended only if a PEBB member experiences a qualifying event.

PEBB Continuation Coverage (Unpaid Leave)

A temporary extension of PEBB insurance coverage for employees who lose eligibility for the employer contribution toward PEBB benefits due to specific types of leave, such as active duty in the uniformed services and authorized leave without pay.

Am I eligible?

For COBRA

Each person who loses their PEBB health plan coverage due to a qualifying event has an independent election right to PEBB Continuation Coverage (COBRA).

Real-world example

If an employee loses their PEBB employer-based group health plan due to a qualifying event, their eligible spouse or state-registered domestic partner (SRDP) may choose continuation coverage, even if the employee does not. Either the employee or their spouse or SRDP may choose continuation coverage for any dependent children.

For Unpaid Leave

Employees who lose their PEBB employer-based group health plan due to a qualifying event may choose PEBB Continuation Coverage (Unpaid Leave) for themselves and their dependents. The employee must choose this coverage for dependents to have coverage. Dependents do not have independent election rights.

Qualifying events

A qualifying event is a life event that causes loss of coverage. See related laws and rules at the bottom of this page for more information.

For COBRA

Employee

• Your employment ended for any reason other than gross misconduct.
• Your hours of employment were reduced below the number of hours required to be eligible for the employer contribution toward PEBB benefits.

Spouse

• Your spouse (the employee, retiree, or other eligible subscriber) died. You may qualify for PEBB Continuation Coverage (COBRA) or in some cases, PEBB retiree insurance coverage.
• Your spouse's hours of employment were reduced.
• Your spouse's employment ended for any reason other than gross misconduct.
• You and your spouse have experienced a divorce, annulment, or dissolution of marriage.

State-registered domestic partner (SRDP)

• Your SRDP (the employee, retiree, or other eligible subscriber) died. You may qualify for PEBB Continuation Coverage (COBRA) or in some cases, PEBB retiree insurance coverage.
• Your SRDP's hours of employment were reduced.
• Your SRDP's employment ended for any reason other than gross misconduct.
• Your state-registered domestic partnership ended.

Dependent children

• Your parent (the employee, retiree, or other eligible subscriber) died. You may qualify for PEBB Continuation Coverage (COBRA) or in some cases, PEBB retiree insurance coverage.
• Your parent's hours of employment were reduced.
• Your parent's employment ended for any reason other than gross misconduct.
• Your eligibility for PEBB health plan coverage as a dependent child ended.

SRDP's child

• Your parent's SRDP (the employee, retiree, or other eligible subscriber) dies. You may qualify for PEBB Continuation Coverage (COBRA) or in some cases, PEBB retiree insurance coverage.
• Your parent's SRDP's hours of employment are reduced.
• Your parent's SRDP's employment ends for any reason other than gross misconduct.
• Your eligibility for PEBB health plan coverage as a dependent child ended.

Retiree or retiree's dependent

• You are a retiree and the Department of Retirement Systems has determined that you are no longer disabled, so your pension has stopped.
• You are a retiree and you or your dependent did not meet the procedural requirement to enroll or stay enrolled in Medicare Part A and Part B as required by PEBB Program rules.

For Unpaid Leave

• You are on authorized leave without pay from your employer.
• Your employment ends due to a layoff.
• You reverted to a position that is not eligible for the employer contribution toward PEBB benefits.
• You are appealing a dismissal action.
• You are receiving time-loss benefits under workers' compensation.
• You are applying for disability retirement.
• You are called to active duty in the uniformed services, as defined under USERRA.
• You are on approved educational leave.
• You are a faculty member who is between periods of eligibility.
• You are a seasonal employee who is between periods of eligibility.

If you are called to active duty or on approved educational leave, you may continue your long-term disability insurance.

How long does coverage last?

Your maximum coverage period is determined by the qualifying event that caused you to lose PEBB coverage. In some situations, coverage can end before the maximum coverage period. See related laws and rules at the bottom of the page for more information.

Termination of employment or reduction of hours

Eligible member

• Employee
• Spouse
• State-registered domestic partner
• Children

Maximum continuation coverage (COBRA) period

18 months

Additional months of coverage may be available under PEBB Continuation Coverage (Unpaid Leave).

Note: In certain circumstances, qualified beneficiaries eligible for 18 months of PEBB Continuation Coverage (COBRA) may become eligible for an extension. A disability extension provides an additional 11 months of coverage (for a total maximum of 29 months). An extension due to a second qualifying event provides an additional 18 months of coverage (for a total maximum of 36 months).

Eligible for Medicare within 18 months before termination of employment or reduction of hours

Eligible member

• Employee
• Spouse
• State-registered domestic partner
• Children

Maximum continuation coverage (COBRA) period

Up to 36 months, measured from the date of the employee's Medicare enrollment.

Authorized leave without pay

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

29 months

An employee who is no longer eligible for PEBB Continuation Coverage (Unpaid Leave), but who has not used the maximum number of months allowed under PEBB Continuation Coverage (COBRA), may continue medical, dental, or both for the remaining months allowed under COBRA.

Employment ends due to layoff

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

29 months

An employee who is no longer eligible for PEBB Continuation Coverage (Unpaid Leave), but who has not used the maximum number of months allowed under PEBB Continuation Coverage (COBRA), may continue medical, dental, or both for the remaining months allowed under COBRA.

Receiving time-loss benefits under workers' compensation

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

29 months

An employee who is no longer eligible for PEBB Continuation Coverage (Unpaid Leave), but who has not used the maximum number of months allowed under PEBB Continuation Coverage (COBRA), may continue medical, dental, or both for the remaining months allowed under COBRA.

Applying for disability retirement

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

29 months

An employee who is no longer eligible for PEBB Continuation Coverage (Unpaid Leave), but who has not used the maximum number of months allowed under PEBB Continuation Coverage (COBRA), may continue medical, dental, or both for the remaining months allowed under COBRA.

Called to active military duty, as defined by USERRA

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

29 months

An employee who is no longer eligible for PEBB Continuation Coverage (Unpaid Leave), but who has not used the maximum number of months allowed under PEBB Continuation Coverage (COBRA), may continue medical, dental, or both for the remaining months allowed under COBRA.

Approved educational leave

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

29 months

An employee who is no longer eligible for PEBB Continuation Coverage (Unpaid Leave), but who has not used the maximum number of months allowed under PEBB Continuation Coverage (COBRA), may continue medical, dental, or both for the remaining months allowed under COBRA.

Reverting to a position that is not eligible for the employer contribution toward PEBB benefits

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

18 months

An employee who is no longer eligible for PEBB Continuation Coverage (Unpaid Leave), but who has not used the maximum number of months allowed under PEBB Continuation Coverage (COBRA), may continue medical, dental, or both for the remaining months allowed under COBRA.

Faculty or seasonal employee between periods of eligibility

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

12 months

Faculty and seasonal employees who use up the 12 months of PEBB Continuation Coverage (Unpaid Leave) may continue coverage for the remaining months allowed under PEBB Continuation Coverage (COBRA).

Appealing a dismissal action

Eligible member

Employee

Note: Employee must enroll to cover dependents. Dependents do not have independent election rights under PEBB Continuation Coverage (Unpaid Leave).

Maximum continuation coverage (Unpaid Leave) period

29 months

If the dismissal is upheld and the employee has not used the maximum number of months allowed under PEBB Continuation Coverage (COBRA), they may continue medical, dental, or both for the remaining months allowed under COBRA.

Death of employee, retiree, or other eligible subscriber

Eligible member

• Spouse
• State-registered domestic partner
• Children

Note: If the qualifying event is the death of an emergency service personnel killed in the line of duty, the death of an employee or retiree, or death of an elected or full-time appointed official, surviving dependents may be eligible for PEBB retiree insurance coverage. Under PEBB retiree insurance coverage, the spouse or state-registered domestic partner may continue coverage until their death, and children may continue coverage until they lose eligibility for PEBB benefits.

Maximum continuation coverage (COBRA) period

36 months

PEBB retiree insurance coverage may also be available in certain cases.

Divorce, annulment, dissolution, or termination of a state-registered domestic partnership

Eligible member

• Spouse
• State-registered domestic partner
• Step-children

Maximum continuation coverage (COBRA) period

36 months

Child loses eligibility under PEBB Program rules

Eligible member

Children

Maximum continuation coverage (COBRA) period

36 months

Are there other options?

Yes. You and your dependents may have other coverage options through the Health Insurance Marketplace, Medicaid, or other group health plan coverage (such as a spouse's plan).

If you are a retiree who lost eligibility to participate in PEBB retiree insurance coverage because your employer group ended participation in PEBB or SEBB insurance coverage on or before January 1, 2023, you may be eligible to enroll in PEBB Continuation Coverage (Employer Group Ended Participation).

PEBB Continuation Coverage (Employer Group Ended Participation)

A state law that took effect May 4, 2023, allows retirees and disabled employees of an employer group that lose eligibility for PEBB retiree insurance coverage due to their employer group ending participation in PEBB or SEBB insurance coverage to enroll in PEBB health plan coverage (medical, dental, or both) on a self-pay basis. You may enroll your dependents and coverage will continue as long as premiums and applicable premium surcharges are paid.

Enroll in coverage

Learn how to enroll in PEBB Continuation Coverage (Employer Group Ended Participation) and find premiums for Medicare and non-Medicare.

What's different about this coverage from PEBB retiree insurance coverage?

If you enroll in this coverage, you cannot:

• Defer (postpone) PEBB coverage for other employer-sponsored coverage and enroll in PEBB coverage later.
• Enroll in PEBB retiree life insurance.
• Receive a state-funded contribution toward your monthly premium if enrolled in Medicare Part A and Part B.
• Pay for your monthly premiums or premium surcharges by pension deduction.

Related laws and rules

Continuation coverage

• WAC 182-12-146: When is an enrollee eligible to continue public employees benefits board (PEBB) benefits under Consolidated Omnibus Budget Reconciliation Act (COBRA)?
• WAC 182-12-142: What options for continuation coverage are available to faculty and seasonal employees who are between periods of eligibility?
• WAC 182-12-133: What options for continuation coverage are available to employees and their dependents during certain types of leave or when employment ends due to a layoff?
• WAC 182-12-148: What options for continuation coverage are available to employees during their appeal of dismissal?
• WAC 182-12-141: If an employee reverts from an eligible position, what happens to their public employees benefits board (PEBB) insurance coverage?

Surviving dependent eligibility

• 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?
• 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?

Dependents

• WAC 182-12-260: Who are eligible dependents?

Employer groups

• WAC 182-08-245(7): Employer group and board members of school districts and educational service districts participation requirements.
• WAC 182-12-5100: What options for health plan enrollment are available to a retired employee of an employer group that previously ended participation in public employees benefits board (PEBB) insurance coverage?
• WAC 182-12-5120: What options for continuing health plan enrollment are available to a retiree of an employer group that ends participation in public employees benefits board (PEBB) or school employees benefits board (SEBB) insurance coverage?