Hourly and salaried employees

Providing notice of the determination of eligibility

Employers must provide written notice of the determination of eligibility (or ineligibility) for the employer contribution toward PEBB benefits to employees within five business days of a newly hired employee's first day of work and when there is a change in eligibility (Section 5(b) of the Interlocal Agreement).

The eligibility worksheets serve as the approved method for determining eligibility for PEBB benefits and providing required notice.

• Use the A-1 worksheet for newly hired hourly or salary employees, including those who are transferring from another PEBB employer with a break* in PEBB benefits.
• Use the A-5 worksheet for newly hired employees transferring from another PEBB employer without a break* in PEBB benefits.
• Use the B-1 worksheet for existing employees who were not initially determined to be benefits-eligible but have a change or revision in work pattern in their first season.
  • The B-1 is also used to monitor the work hours of ineligible employees each month in case eligibility is established based on work pattern (6-month-look-back).
• Use the B-4 worksheet for eligible hourly or salaried employees who experience a change in their current position (e.g., reduction of work hours), and employees who move to a new position at the same employer.

How is eligibility determined for hourly and salaried employees?

Employee eligibility for the employer contribution toward PEBB benefits is determined in accordance with Title 182 WAC and any additional policies, procedures, or written guidance issued by the PEBB Program.

PEBB participating employer groups may have different eligibility criteria, if approved by the PEBB Program (PEBB Policy 90-3). Any approved criteria will be outlined in Appendix A of your organization's Interlocal Agreement.

Establishing eligibility for the employer contribution upon hire

Newly hired employees who will work on an hourly or salaried basis are eligible from the date of employment (typically the first day of work) if the employer anticipates they will work (WAC 182-12-114(1)):

• An average of at least eighty hours per month,
• At least eight hours in each month, and

• For more than six consecutive months.

When anticipating an employee's work hours:

• Only include the hours an employee is anticipated to actually work. Do not include holiday or leave hours.
• Combine (stack) the hours and consecutive months worked from all positions or jobs (except faculty) within one employer.

What hours are excluded when determining eligibility?

The following hours must be excluded when anticipating an employee's work hours to determine eligibility:

• Standby hours and temporary increases in work hours, of 6 months or less, caused by training or emergencies (except governor-declared emergencies) that have not been or are not anticipated to be part of the employee's regular work schedule or pattern.
  • Standby hours are determined by the employer.
  • Employers must request the PEBB Program's approval to include temporary training or emergency hours when determining eligibility.

Employees determined to be eligible for PEBB benefits upon hire

Employees determined to be eligible for PEBB benefits have 31-days after the date they become eligible to elect PEBB benefits by submitting enrollment forms and dependent verification documents (if applicable) to their benefits administrator (BA). However, eligible employees must have no less than ten calendar days after the date of receiving notice to elect coverage.

Learn about when benefits begin and the requirements and processes for enrolling newly eligible employees.

Employees determined to be ineligible for PEBB benefits upon hire

Employees who do not meet the eligibility criteria listed above may establish eligibility through stacking hours or may become eligible at a later date if the employer revises their anticipated work pattern or based on their work pattern.

Use the B-1 worksheet to track their work hours each month in case they become eligible based on work pattern. When using the B-1 worksheet, only include the hours an employee actually worked or is anticipated to work. Do not include holiday or leave hours.

• Holiday hours are not considered hours worked.
• L​​​​​​eave hours do not count toward or add to an employee's work hours for the purpose of determining eligibility because they are replacing hours that the employee was already anticipated to work.

Establishing eligibility through stacking work hours or based on work pattern

Establishing eligibility through stacking work hours

Employees may "stack" or combine hours worked in more than one position or job within one employer to establish eligibility and maintain the employer contribution toward PEBB benefits.

Employees must notify their employer if they believe they are eligible through stacking. They become eligible through stacking when they meet the requirements described above and in WAC 182-12-114(1).

Stacking includes work situations in which employees:

• Work two or more positions or jobs at the same time (concurrent stacking), or
• Move from one position or job to another (consecutive stacking) or
  • An employee may not consecutively stack hours when there is a break in PEBB benefits.
• Combine hours from a seasonal position with hours from a nonseasonal position or job.

  • Employees combining seasonal and nonseasonal hours maintain eligibility each month in which they are in pay status eight or more hours per month.

Complete and provide the A-1 worksheet to employees who are determined eligible through stacking.

Establishing eligibility based on work pattern

Newly hired employees determined to be ineligible for the employer contribution may establish eligibility at a later date:

• Upon revision of anticipated work pattern
  • If the employer revises an employee's anticipated work hours or anticipated duration of employment such that the employee meets the eligibility criteria for PEBB benefits, the employee becomes eligible when the revision is made.
• Based on work pattern (hours worked)
  • An employee who is determined to be ineligible, but later works an average of at least 80 hours per month, for at least eight hours in each month, and for more than six consecutive months becomes eligible the first of the month following the six-month averaging period.

Complete and provide the B-1 worksheet to existing employees who were not initially determined to be eligible but who later establish eligibility.

How do employees maintain eligibility for the employer contribution?

Employees who have established eligibility for benefits maintain eligibility each month in which they are in pay status eight or more hours per month (WAC 182-12-131 (1)).

"Pay status" means all hours for which an employee receives pay.

Transferring from one PEBB employer to another

Employees are considered a "transfer" when they move from one PEBB employer to an eligible position with another PEBB employer without a break in PEBB benefits. A break in PEBB benefits is one month or more in which an employee does not receive the employer contribution.

The table below provides examples to assist in determining if an employee has a break in PEBB benefits.

See below for guidance on employees who are and are not considered a "transfer".

Employees who do not experience a break in PEBB benefits (transfers)

Employees who move from one PEBB employer to another without a break in benefits, and are eligible in their new position:

• Are considered a transfer (not newly eligible), and
• Cannot make new benefit elections (their benefit elections remain the same).
  • Employees may be allowed to make changes if a qualifying special open enrollment event occurs.

Exception

Employees transferring from an employer group that offers medical-only to an employer who offers full-benefits (medical, dental, life and AD&D, and LTD) will be allowed to make new elections for all benefits, except medical.

Complete the A-5 worksheet for incoming and outgoing employee transfers.

Employees who experience a break in PEBB benefits

Employees who move from one PEBB employer to another with a break in benefits, and are eligible in their new position:

• Are considered newly eligible, and
• Must make new benefit elections within 31-days of becoming eligible.

Complete the A-1 worksheet to determine and provide required notice of eligibility.

Related rules and policies

WAC 182-12-109: Definitions

WAC 182-12-113: What are the obligations of a state agency (employer) in the application of employee eligibility?

WAC 182-12-114: How do employees establish eligibility for PEBB benefits?

WAC 182-12-131: How do eligible employees maintain the employer contribution toward PEBB benefits?

WAC 182-08-197: When must a newly eligible employee, or an employee who regains eligibility for the employer contribution, elect PEBB benefits and complete required forms?

PEBB Policy 11-1: Providing a notice to an employee