PEBB Continuation Coverage (COBRA)
The Health Care Authority administers PEBB Continuation Coverage (COBRA), a temporary extension of PEBB medical and/or dental coverage, for eligible members (employees and dependents) who lose eligibility for the employer contribution toward PEBB benefits.
Employees may qualify for PEBB Continuation Coverage (Unpaid Leave), which may allow a longer coverage period and additional benefits.
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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 or dependent'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 COBRA?
Each member (employee or dependent) who loses their PEBB health plan coverage due to a qualifying event has an independent right to elect to continue medical coverage, dental coverage, or a combination of both by enrolling in PEBB Continuation Coverage (COBRA) on a self-pay basis.
For example, if an employee loses their PEBB employer-based group health plan due to a qualifying event, their eligible spouse or state-registered domestic partner (SRDP) may choose continuation coverage, even if the employee does not. Either the employee or their spouse or SRDP may choose continuation coverage for any dependent children.
- Qualifying events
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A qualifying event is a life event that causes loss of coverage.
Examples of qualifying events for an employee are:
- Employment ending for any reason other than gross misconduct.
- Hours of employment are reduced below the number of hours required to be eligible for the employer contribution toward PEBB benefits.
- Eligibility is maintained when the employee is in pay status of eight or more hours per month (or 5% for faculty).
Examples of qualifying events for a spouse or state-registered domestic partner (SRDP) are:
- The spouse (employee) dies. The surviving spouse/SRDP may qualify for COBRA or PEBB retiree insurance coverage.
- The employee's hours of employment are reduced below the number of hours required to be eligible for the employer contribution toward PEBB benefits.
- The employee's employment ends for any reason other than gross misconduct.
- The employee and spouse experience a divorce, annulment, or dissolution of marriage.
- Their state-registered domestic partnership (with the employee) ends.
Examples of qualifying events for dependent children are:
- The parent (employee) dies.
- The employee's hours of employment are reduced below the number of hours required to be eligible for the employer contribution toward PEBB benefits.
- The employee's employment ends for any reason other than gross misconduct.
- Eligibility for PEBB benefits as a dependent child ends.
How do eligible PEBB members enroll in COBRA?
To enroll in COBRA, the member (employee or dependent) must complete and return the PEBB Continuation Coverage (COBRA) 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 COBRA begin?
If elected, benefits begin the first day of the month following the date PEBB benefits as an eligible employee or dependent ended.
For example, if PEBB benefits as an eligible employee or dependent end on September 30, coverage under COBRA will begin October 1.
How long does coverage under COBRA last?
The maximum coverage period for COBRA can last anywhere from 12 to 36 months and is determined by the qualifying event that caused the employee or dependent to lose eligibility for the employer contribution toward PEBB benefits. In some situations, coverage under COBRA 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 life insurance under portability or conversion
PEBB Continuation Coverage (COBRA) subscribers who are eligible and wish to continue life insurance under portability or conversion must complete and submit the form sent to them by MetLife after their PEBB benefits were terminated. MetLife must receive the form no later than 60 days after PEBB employee life insurance ends.
Learn more about portability and conversion options for continuing life insurance.
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 182-12-131: 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 182-12-141: 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 182-12-146: When is an enrollee eligible to continue PEBB benefits under COBRA?
- WAC 182-12-148: What options for continuation coverage are available to employees during their appeal of dismissal?
- WAC 182-12-270: What options for continuation coverage are available to dependents who cease to meet the eligibility criteria as described in WAC 182-12-260?