Defer as a survivor

For survivors of eligible employees and retirees

When an employee or retiree passes away, their spouse, state-registered domestic partner, or child who loses eligibility due to the death may enroll in or defer enrollment in PEBB retiree insurance coverage as a survivor.

What do I do?

To defer PEBB retiree insurance coverage, you must:

• Submit the Retiree Election Form (form A) to the PEBB Program.
• Submit any other required forms or documents based on your situation.

To enroll in the future, you must be continuously enrolled in qualified medical coverage and submit the required forms by the deadline. Visit How do I enroll after deferring? for details.

By when?

The PEBB Program must receive your forms and documents within the following timelines. For eligible survivors of an:

Employee

No later than 60 days after the date of your loved one's death or the date your PEBB, SEBB, or educational service district insurance coverage ends, whichever is later.

Retiree

No later than 60 days after your loved one's death.

Elected or full-time appointed official

No later than 60 days after the date of your loved one's death or the date your PEBB insurance coverage ends, whichever is later.

For survivors of emergency service personnel

What do I do?

To defer enrollment in PEBB retiree insurance coverage, you must:

• Submit the Retiree Election Form (form A) to the PEBB Program.
• Submit any other required forms or documents based on your situation.

To enroll in the future, you must be continuously enrolled in qualified medical coverage and submit the required forms by the deadline. Visit How do I enroll after deferring? for details.

By when?

The PEBB Program must receive your forms no later than 180 days after the latest of these events:

• The death of your loved one.
• The date on the letter from the Department of Retirement Systems (DRS) or the Board for Volunteer Firefighters and Reserve Officers that informs you that you are eligible.
• The last day you are covered under any health plan (including COBRA coverage) through your loved one's employer.

For more on how to defer, see For enrolled members who want to defer. This will tell you what to do, by when.

Questions about deferring or deadlines?

Please call the PEBB Program at 1-800-200-1004 (TRS: 711) or send us a secure message through HCA Support, a secure website that allows you to log into your own account to communicate with us. You will need to set up a SecureAccess Washington (SAW) account to use this option.

Supporting information

What is qualified medical coverage?

Qualified medical coverage is enrollment in other insurance, for example, through your spouse or state-registered domestic partner, or military affiliation. This may include:

• Enrollment as a dependent in a Washington State educational service district-sponsored, PEBB-sponsored, or SEBB-sponsored health plan
• Employer-based group medical (including COBRA or continuation coverage)
• Federal retiree medical plan such as a TRICARE plan or Federal Employees Health Benefits Program
• Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
• Medicare Part A and Part B and a Medicaid program that provides creditable coverage
• Enrollment in health benefit exchange coverage that is not Medicaid – for retirees not enrolled in Medicare Part A and Part B

Forms and documents you may need to submit

Required forms

• Retiree Election Form (form A). Everyone must submit this form to enroll in or defer enrollment.
• Retiree Change Form (form E). Submit this form to make changes to an existing retiree account.
• Medicare Advantage Disenrollment Form (form D). This is a request to cancel enrollment in a PEBB Medicare Advantage plan.

Supporting documents you may need

• Proof of enrollment in Medicare Part A and Part B
• Dependent verification documents

Related laws and rules

For retiring employees and retirees

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), a Washington State educational service district, or school employees benefits board (SEBB) defer enrollment under PEBB retiree insurance coverage?

For retirees and survivors: defer or voluntarily terminate

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?

For elected and full-time appointed officials and their 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?

For survivors of emergency service personnel killed in the line of duty

WAC 182-12-250: Public employees benefits board (PEBB) insurance coverage eligibility for survivors of emergency service personnel killed in the line of duty.

Continuing enrollment when an employee or retiree dies

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?