Am I eligible?

Who is eligible?

Retiring or separating employees of a:

• State agency.
• State higher-education institution.
• PEBB-participating employer group.
• Washington school district, educational service district, or charter school.

Or:

• A surviving dependent.
• An elected or full-time appointed official of the legislative or executive branch of state government who leaves public office.

For legal definitions, refer to Related laws and rules at the bottom of this page.

What if I am eligible as a retiree and a dependent?

You cannot enroll in medical or dental coverage under two PEBB accounts. If you and your spouse or state-registered domestic partner (SRDP) are both eligible, you will need to decide which of you will enroll and cover the other as a dependent. You may also enroll separately if you and your spouse or SRDP are both eligible.

Real-world example

You and your SRDP are independently eligible for PEBB retiree insurance coverage. Since you cannot have medical or dental coverage under two accounts, you decide to defer your enrollment in PEBB retiree insurance coverage and enroll as a dependent on your SRDP's PEBB retiree insurance coverage.

How is eligibility determined?

The PEBB Program determines eligibility once you submit the Retiree Election Form (form A) and supporting documents. We use the eligibility rules and requirements defined by Washington Administrative Codes (WACs). Refer to Related laws and rules at the bottom of this page.)

There are two types of requirements

You must meet both.

• Procedural (enrollment/deferment) requirements = tasks you must complete within a certain timeframe
• Eligibility requirements = criteria you must meet

How does enrollment or deferral work?

1. Meet the criteria to enroll in or defer enrollment in PEBB retiree insurance coverage. The PEBB Program will determine if you meet criteria once you submit your forms and supporting documents.
2. Submit your forms, any required documents, and first payment (if enrolling). We must receive your materials by the deadline. Eligibility is based on receipt date, not postmark.
3. The PEBB Program determines your eligibility. If you submit an incomplete application, we will contact you requesting more information.
4. If you are found eligible, enrollment or deferral begins, based on your situation and when we receive your materials. If you are not eligible, we will notify you, explain why, and list possible next steps.

Tasks you must do and criteria you must meet

What you need to do – and the criteria you must meet – depends on your situation and whether you are enrolling in, or deferring enrollment in, PEBB retiree insurance coverage.

For details visit:

• How do I enroll?
• How do I defer?

Can I lose eligibility?

Yes. There are a number of reasons you might lose eligibility, such as:

• You miss a deadline for enrolling or deferring.
• You no longer meet the criteria to enroll or defer.
• You defer coverage and are unable to provide proof of other qualifying medical coverage when you wish to enroll after deferral.
• You choose to cancel coverage.
• You don't pay your monthly premiums and applicable premium surcharges timely.
• You fail to respond to a request from the PEBB Program for information about Medicare Part A and Part B for you or a dependent, or an action required due to enrolling in Medicare Part D.

How do I make sure I don't lose eligibility?

The most important thing you can do to protect your eligibility is to submit Retiree Election Form (form A) by the required deadline.

For details on what you must do, when you must do them, and what criteria you must meet, visit How do I enroll? or How do I defer?

If I lose eligibility, can I become eligible again?

Yes, you can become eligible again by returning to employment with a PEBB employing agency or SEBB organization in a position where you are eligible for PEBB or SEBB benefits and, when you leave employment, meet the procedural (enrollment/deferment) and eligibility requirements.

Related laws and rules

Washington Administrative Codes (WAC) are the official rules used for PEBB Program eligibility and deferral.

Eligibility-related

For employees

• WAC 182-12-171: When is a retiring employee or a retiring school employee eligible to enroll in public employees benefits board (PEBB) retiree insurance coverage?
• 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 public employees benefits board (PEBB) retiree insurance coverage?

For elected or full-time appointed officials

• 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

• 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?
• 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?

Deferral-related

• 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?
• 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?