How do I enroll after deferring?

Before you begin: proof of continuous coverage

When you apply for enrollment after your deferral, you must provide proof that you were continuously enrolled in one or more qualifying medical coverages, including the start date and in most cases the end dates for each coverage. You will need proof of coverage for each qualified coverage while you are in a deferred status.

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.

If you or a dependent are eligible for Medicare, the eligible person must enroll and stay enrolled in Medicare Part A and Part B to enroll in and remain enrolled in a PEBB retiree health plan. 

When can I enroll?

You can enroll in a PEBB retiree health plan after you defer:

• During the PEBB Program's open enrollment
• When other qualified medical coverage ends (this will be based on your situation)
• After deferring coverage for Medicare and Medicaid

Find and submit your forms

You can use Benefits 24/7 to enroll in 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. You will often need to submit more than one form. 

To enroll in a PEBB retiree health plan after you defer, you may need one or more of these retiree forms: 

• Form A – For enrolling when your other qualified medical coverage ends
• Form B – For enrolling in Premera Blue Cross Medicare Supplement Plan G
• Form A-OE – For enrolling during annual open enrollment. (This form is available during open enrollment.)

I need Form A to enroll in...

To enroll in any of the following medical plans:

• Kaiser Permanente NW: Classic, Consumer-Directed Health Plan (CDHP), or Senior Advantage with Part D
• Kaiser Permanente WA: Classic, CDHP, SoundChoice, Value, or Medicare Advantage with Part D
• Uniform Medical Plan (UMP): Classic, Select, CDHP, or Classic Medicare with Part D
• UMP Plus–Puget Sound High-Value Network (PSHVN) or UMP Plus–UW Medicine Accountable Care Network (ACN)
• UnitedHealthcare: PEBB Balance or PEBB Complete

Submit these forms and documentation:

• Retiree Election Form (form A)
• Proof of continuous enrollment in one or more qualifying coverages
• Any other required forms or documents listed on Form A, based on your situation

By when?

No later than 60 days after the date your other qualifying medical coverage ends.

Note: If you choose a Medicare Advantage with Part D plan or UMP Classic Medicare with Part D, enrollment may not be retroactive. We encourage you to submit your forms so we receive them no later than the last day of the month before the date your PEBB retiree insurance coverage is to begin. Otherwise, you and your dependents will be enrolled in another medical plan during the gap months prior to when the Medicare plan begins.

When will coverage begin?

Coverage will begin the first day of the month after your other qualifying medical coverage ends.

I need both Forms A and B to enroll in...

To enroll in the following medical plan:

• For Premera Blue Cross Medicare Supplement Plan G

Submit these forms and documentation:

• Retiree Election Form (form A)
• Premera Medicare Supplement Plan G Enrollment Form (form B)
• Proof of continuous enrollment in one or more qualifying coverages
• Any other required forms or documents listed on Form A, based on your situation

By when?

No later than 60 days after the date your other qualifying medical coverage ends.

When will coverage begin?

Coverage will begin the first day of the month after your other qualifying medical coverage ends.

I need Form A-OE to enroll...

During annual open enrollment.

• Submit the Retiree Open Enrollment Election/Change Form (form A-OE) to the PEBB Program.
• Submit proof of continuous enrollment in one or more qualifying coverages.
• Submit any other required forms or documents listed on Form A-OE, based on your situation.

By when?

No later than the last day of open enrollment.

When will coverage begin?

January 1 of the next year.

Can I enroll after deferring coverage for Medicare and Medicaid?

Yes. If you deferred while enrolled in Medicare Part A and Part B and a Medicaid program that provides creditable coverage and you do not enroll during the timeframes described above, you may enroll in a PEBB retiree health plan:

No later than the end of the calendar year in which your Medicaid coverage ends.

Do I have to pay premiums?

Yes. Although you have 60 days to enroll, you must pay your first monthly premiums and applicable premium surcharges no later than 45 days after your 60-day enrollment window ends. Premiums are due back to when your other qualifying medical coverage ended.

We cannot enroll you in coverage until we receive your first payment.

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 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 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?