How do I defer?

You must stay enrolled in qualified coverage

Deferring is a formal process that allows you to pause or postpone enrollment in PEBB retiree insurance coverage but lets you stay eligible to enroll in the future. The process involves checking that you are eligible to defer, then submitting forms and documents within a given timeframe.

If you defer, in most cases, you also defer enrollment for your dependents.

To be eligible to enroll later, you must provide proof of continuous enrollment in qualifying medical coverage while you are deferred.

If you defer enrollment while enrolled in Medicare and permanently living outside of the United States, you must provide proof of enrollment in Medicare Parts A and B to return to a PEBB retiree health plan after deferral. Evidence of continuous enrollment in a qualified coverage is waived while you live outside of the United States.

Things you must do and their deadlines

These are the things you must do – and when you must do them – to be eligible to defer PEBB retiree insurance coverage for yourself and your dependents.

If you want to defer, you must submit the required forms to the PEBB Program. After that, what you do depends on your situation.

If you are already enrolled in PEBB retiree insurance coverage and you return to work and become eligible for the employer contribution toward PEBB benefits, PEBB retiree insurance coverage is automatically deferred. You do not need to submit a form.

For eligible retiring or separating employees

What do I do?

To defer enrollment, you must:

• Submit your request in Benefits 24/7 or return the Retiree Election Form (form A) to the PEBB Program by the required deadline.
• Submit any other forms or documents, based on your situation.

To enroll in the future, you must provide proof of continuous enrollment in qualifying medical coverage while you are deferred. If you defer enrollment while enrolled in Medicare and permanently living outside of the United States, you must provide proof of enrollment in Medicare Parts A and B to return to a PEBB retiree health plan after deferral. Evidence of continuous enrollment in a qualified coverage is waived while you live outside of the United States.

Note: A gap in coverage of 31 days or less is allowed between the date you defer PEBB retiree insurance coverage and the start date of a qualified coverage, and between each period of enrollment in qualified coverages during the deferral period. We encourage you to collect proof of coverage annually and keep a file to provide to the PEBB Program in the event you want to return in the future.

By when?

The PEBB Program must receive your form no later than 60 days after your employer-paid, COBRA, or continuation coverage ends.

When does the deferral take effect?

If you are eligible to defer and submit your form by the deadline, we will defer your enrollment the first of the month after the date your employer-paid, COBRA, or continuation coverage ends.

For elected or full-time appointed officials leaving public office

What do I do?

To defer enrollment, you must:

• Submit your request using Benefits 24/7 or return the Retiree Election Form (form A) to the PEBB Program by the required deadline.
• Submit any other forms or documents, based on your situation.

To enroll in the future, you must provide proof of continuous enrollment in qualifying medical coverage while you are deferred. If you defer enrollment while enrolled in Medicare and permanently living outside of the United States, you must provide proof of enrollment in Medicare Parts A and B to return to a PEBB retiree health plan after deferral. Evidence of continuous enrollment in a qualified coverage is waived while you live outside of the United States.

Note: A gap in coverage of 31 days or less is allowed between the date you defer PEBB retiree insurance coverage and the start date of a qualified coverage, and between each period of enrollment in qualified coverages during the deferral period. We encourage you to collect proof of coverage annually and keep a file to provide to the PEBB Program in the event you want to return in the future.

By when?

The PEBB Program must receive your form no later than 60 days after you leave public office.

When does the deferral take effect?

If you are eligible to defer and submit your form by the deadline, we will defer your enrollment the first of the month after the date you leave public office.

For surviving dependents

If you are a survivor or a dependent becoming eligible as a survivor and are ready to defer, visit Defer as a survivor.

If you have questions about eligibility, visit Are my survivors eligible?

For employees eligible for disability retirement

What do I do?

To defer enrollment, you must:

• Be approved by the Department of Retirement Systems (DRS) or the appropriate higher-education authority for disability retirement.
• Submit a copy of the formal determination letter from DRS (or the appropriate higher-education authority) approving the disability retirement.
• Submit your request using Benefits 24/7 or return the Retiree Election Form (form A) to the PEBB Program by the required deadline.
• Submit any other required forms or documents, based on your situation.

To enroll in the future, you must provide proof of continuous enrollment in qualifying medical coverage while you are deferred. If you defer enrollment while enrolled in Medicare and permanently living outside of the United States, you must provide proof of enrollment in Medicare Parts A and B to return to a PEBB retiree health plan after deferral. Evidence of continuous enrollment in a qualified coverage is waived while you live outside of the United States.

Note: A gap in coverage of 31 days or less is allowed between the date you defer PEBB retiree insurance coverage and the start date of a qualified coverage, and between each period of enrollment in qualified coverages during the deferral period. We encourage you to collect proof of coverage annually and keep a file to provide to the PEBB Program in the event you want to return in the future.

By when?

Your form and formal determination letter must be received by the PEBB Program no later than 60 days after the date on the formal determination letter approving the disability retirement.

When does the deferral take effect?

If you are eligible to defer and submit your form and documents by the deadline, we will defer your enrollment as you request on the form. Either;

• Your disability retirement date, or
• The first day of the month after the date the letter was written.

as of the retirement date on the determination letter or the first day of the month after the date the letter was written

For enrolled members who want to defer

If you are already enrolled in PEBB retiree insurance coverage, you may want to defer enrollment because you have other qualifying medical coverage.

What do I do?

To defer enrollment, you must:

• Submit your request in Benefits 24/7 or return the Retiree Change Form (form E) to the PEBB Program.
• Submit any other required forms or documents, based on your situation.
• If you become eligible for the employer contribution toward PEBB benefits, PEBB retiree insurance coverage will be automatically deferred. You will be exempt from the deferral form requirement.

To reenroll in the future, you must be continuously enrolled in qualified medical coverage while you are deferred. If you defer enrollment while enrolled in Medicare and permanently living outside of the United States, you must provide proof of enrollment in Medicare Parts A and B to return to a PEBB retiree health plan after deferral. Evidence of continuous enrollment in a qualified coverage is waived while you live outside of the United States.

Note: A gap in coverage of 31 days or less is allowed between the date you defer PEBB retiree insurance coverage and the start date of a qualified coverage, and between each period of enrollment in qualified coverages during the deferral period. We encourage you to collect proof of coverage annually and keep a file to provide to the PEBB Program in the event you want to return in the future.

By when?

We encourage you to submit your form before your other qualified medical coverage starts.

When does the deferral take effect?

If you are eligible and submit your forms, we will defer your enrollment the first of the month after the date we receive all the required forms. If we receive the forms on the first day of the month, the deferral will be effective that day.

Medicare Advantage with Part D and UMP Classic Medicare with Part D

If you are enrolled in a Medicare Advantage with Part D plan or UMP Classic Medicare with Part D, enrollment will be deferred effective the first of the month after the date we receive the Medicare Plan Disenrollment Form (form D).

Criteria you must meet

This is the criteria you must meet to be eligible to defer enrollment in PEBB retiree insurance coverage.

Be eligible

You must be eligible to enroll or are already enrolled in PEBB retiree insurance coverage to be eligible to defer. (Refer to Related laws and rules at the bottom of the page for details.)

If you have lost your eligibility to enroll, you cannot defer.

Real-world example

You retired in 2019 and enrolled as a dependent on your spouse's employee medical coverage, so you didn't need PEBB retiree insurance coverage. Maybe you didn't realize you should defer or forgot when you retired. But six years later, when your spouse is ready to retire, you may think about enrolling in PEBB retiree insurance coverage.

Unfortunately, since you did not defer PEBB retiree insurance coverage when you first became eligible in 2019, you lost your eligibility and cannot enroll.

Have other qualified medical coverage

Employer-based group medical insurance as an employee or dependent

• This includes COBRA or continuation coverage.
• This does not include an employer's retiree coverage.

(Beginning January 1, 2001)

Dependent coverage in a:

• PEBB-sponsored medical plan
• SEBB-sponsored medical plan
• Washington State educational service district-sponsored medical plan

This includes COBRA or continuation coverage.

Medical coverage as a retiree or dependent in:

• A TRICARE plan
• The Federal Employees Health Benefits Program

You will have a one-time opportunity to enroll in a PEBB retiree health plan.

(Beginning January 1, 2001)

Medicare Part A and Part B and a Medicaid program that provides creditable coverage

To be considered creditable coverage, your Medicaid coverage must include coverage for medical and hospital benefits.

Any dependents who are not eligible for creditable coverage under Medicaid may stay enrolled in a PEBB retiree health plan.

(Beginning January 1, 2006)

A qualified health plan coverage through a health benefit exchange established under the Affordable Care Act (and you are not eligible for Medicare Part A and Part B)

This does not include Medicaid coverage, known as Apple Health in Washington State.

You will have a one-time opportunity to enroll or reenroll in a PEBB retiree health plan.

(Beginning January 1, 2014)

Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)

You will have a one-time opportunity to enroll in a PEBB retiree health plan.

(Beginning July 17, 2018)

Enrolled in Medicare and permanently live outside of the United States

You are enrolled in Medicare and permanently live in a location outside of the United States.

(Beginning January 1, 2025)

Find your forms

You can use Benefits 24/7 to defer your PEBB retiree insurance coverage. If you prefer a paper form, find the forms you need below.

The forms are labeled with letters in the upper right corner to help you identify them.

When you are first eligible to defer

The only form you have to submit is the Retiree Election Form (form A). In most cases, no other forms or documents are required.

When you enroll in retiree coverage, then later decide to defer

Select the forms you need to submit based on the medical plan you or your dependents are currently enrolled in.

I need Form E only:

For the following medical plans, you only need the Retiree Change Form (form E).

• Kaiser Permanente NW: Classic or CDHP
• Kaiser Permanente WA: Classic, CDHP, SoundChoice, or Value
• Premera Blue Cross Medicare Supplement Plan G
• Uniform Medical Plan (UMP): Classic, Select, or CDHP
• UMP Plus–Puget Sound High Value Network (PSHVN), or UMP Plus–UW Accountable Care Network (ACN)

I need both Forms E and D:

For the following medical plans, you need both the Retiree Change Form (form E) and Medicare Plan Disenrollment Form (form D).

• Kaiser Permanente NW Senior Advantage with Part D
• Kaiser Permanente WA Medicare Advantage with Part D
• UMP Classic Medicare with Part D
• UnitedHealthcare: PEBB Balance or PEBB Complete

Submit your materials

Submit your forms and documentation using one of the following methods.

Electronically

Send us a secure message through HCA Support, a secure website that allows you to log into your own account to communicate with us. Sign and date any forms you attach to a secure message. A typed signature is not acceptable.

To keep your personal information secure, you will need to register for an account (if you don't already have one) to submit your materials using this method.

By mail

Washington State Health Care Authority
PEBB Program
PO Box 42684
Olympia, WA 98504-2684

By fax

360-725-0771

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

Related laws and rules

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 retiring employees or a retiree enrolled as a dependent

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 retiring employees, retirees, and survivors

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 disability retirement

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 a public employees benefits board (PEBB) retiree insurance coverage?