PEBB Continuation Coverage (Unpaid Leave)
The Health Care Authority administers PEBB Continuation Coverage (Unpaid Leave), a temporary extension of PEBB medical, dental, life and accidental death and dismemberment insurance, and in some cases, long-term disability insurance, for employees who lose eligibility for the employer contribution toward PEBB benefits due to going on certain types of leave.
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The Health Care Authority (HCA) is responsible for verifying that all enrollees are notified of their continuation coverage rights within the required time frame. To satisfy this requirement, the HCA has assumed the responsibility for distributing continuation coverage materials, including the:
When will PEBB send the Continuation Coverage Election notice?
When an employee's PEBB coverage/benefits is terminated in the insurance system, the PEBB Program will mail the PEBB Continuation Coverage Election Notice to them no later than 14 days after their coverage has been terminated.
Who is eligible for Unpaid Leave?
Employees who lose eligibility for the employer contribution toward PEBB benefits due to a qualifying event may choose to continue medical coverage, dental coverage (or a combination of both), life and accidental death and dismemberment insurance, and in some cases, long-term disability insurance, by enrolling in PEBB Continuation Coverage (Unpaid Leave) on a self-pay basis.
The employee must choose this coverage for themselves for their eligible dependents to have coverage. Dependents do not have independent election rights to PEBB Continuation Coverage (Unpaid Leave).
- Qualifying events
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A qualifying event is a life event that causes loss of coverage. Examples of qualifying events are:
- Going on authorized leave without pay.
- Employment ending due to a layoff.
- Reverting to a position that is not eligible for the employer contribution toward PEBB benefits.
- Appealing a dismissal action.
- Receiving time-loss benefits under workers' compensation.
- Applying for disability retirement.
- Being called to active duty in the uniformed services, as defined under USERRA.
- Employees called to active duty (USERRA) may also continue long-term disability insurance.
- Going on approved educational leave.
- Employees going on approved educational leave may also continue long-term disability insurance.
- Faculty members between periods of eligibility.
- Seasonal employees between periods of eligibility.
How do employees enroll in Unpaid Leave?
To enroll in Unpaid Leave, the eligible employee must complete and return the PEBB Continuation Coverage (Unpaid Leave) Enrollment/Change form along with the first premium payment to the PEBB Program.
The PEBB Program must receive the:
- Required form and supporting documentation (if applicable) no later than 60 days after PEBB benefits end or from the postmark date on the PEBB Continuation Coverage Election Notice, whichever is later.
- First premium payment, including applicable premium surcharges, are due to the HCA/PEBB Program no later than 45 days after the 60-day election period ends. Explore plan costs on the PEBB Continuation Coverage website.
Enrollment will not be processed until the completed form and first premium payment have been received (within the required time frames).
When does coverage under Unpaid Leave begin?
If elected, benefits begin the first day of the month following the date PEBB benefits as an eligible employee ended.
For example, if PEBB benefits as an eligible employee end on September 30, coverage under Unpaid Leave will begin October 1.
How long does coverage under Unpaid Leave last?
The maximum coverage period for Unpaid Leave can last up to 29 months and is determined by the qualifying event that caused the employee to lose eligibility for the employer contribution toward PEBB benefits. In some situations, coverage under Unpaid Leave can end before the maximum coverage period.
A detailed explanation of the maximum coverage periods for each qualifying event is available on the PEBB Continuation Coverage website.
Continuing participation in a Flexible Spending Arrangement
Employees of state agencies and institutions of higher education who enroll in PEBB Continuation Coverage (Unpaid Leave) may continue their participation in a Flexible Spending Arrangement (FSA).
If an employee is eligible to continue an FSA, Navia Benefit Solutions will mail a COBRA election notice to the employee. Navia must receive the employee's election no later than 60 days from the date PEBB benefits ended, or the postmark date on Navia’s COBRA election notice, whichever is later.
Learn more about continuing participation in a Flexible Spending Arrangement on the PEBB Continuation Coverage website and in the FSA enrollment guides on Navia's website.
- Related rules and policies
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- WAC 182-12-129: What happens when an employee moves from an eligible to an ineligible position or job due to layoff?
- WAC 182-12-131: How do eligible employees maintain the employer contribution toward PEBB benefits?
- WAC 182-12-133: What options for continuation coverage are available to employees on certain types of leave or when employment ends due to layoff?
- WAC 182-12-136: May employees on approved educational leave waive continuation coverage?
- WAC 182-12-141: If an employee reverts from an eligible position, what happens to their public employees benefits board (PEBB) insurance coverage?
- WAC 182-12-142: What options for continuation coverage are available to faculty and seasonal employees who are between periods of eligibility?
- WAC 182-12-148: What options for continuation coverage are available to employees during their appeal of dismissal?