Seasonal employees

Providing notice of the determination of eligibility

Employers must provide written notice of the determination of eligibility (or ineligibility) for the employer contribution toward PEBB benefits to employees within five business days of a newly hired employee's first day of work and when there is a change in eligibility (Section 5(b) of the Interlocal Agreement).

The eligibility worksheets serve as the approved method for determining eligibility for PEBB benefits and providing required notice.

Eligibility worksheets

• Use the A-2 worksheet for:
  • Newly hired seasonal employees, including those who are transferring from another PEBB employer with a break* in PEBB benefits, and
  • Employees returning for a second consecutive season, if they were not eligible during their first season.
• Use the A-5 worksheet for newly hired seasonal employees who are transferring from another PEBB employer without a break* in PEBB benefits.
• Use the B-1 worksheet for existing employees who were not initially determined to be benefits-eligible but have a change or revision in work pattern in their first season.
  • The B-1 is also used to track the work hours of ineligible employees each month in case eligibility is established based on work pattern (6-month-look-back).
• Use the B-5 worksheet for seasonal employees who experience a change in their current position (e.g., reduction of work hours), and who move to a new position at the same employer.
• Use the B-7 worksheet for seasonal employees who change positions or experience a reduction in work hours due to layoff without a break* in PEBB benefits.
• Use the C-4 worksheet for eligible seasonal employees who are leaving work for the off-season.
• Use the D-5 worksheet for seasonal employees who are returning to work from an off-season with no employer contribution.

What is a break in PEBB benefits?

*A break in PEBB benefits is one month or more in which the employee does not receive the employer contribution.

How are seasonal employees defined?

A "seasonal employee" is hired to work during a recurring, annual season with a duration of three months or more and is anticipated to return each season to perform similar work (WAC 182-12-109).

A "season" is any recurring annual period of work at a specific time of year that lasts three to eleven consecutive months.

For example, a seasonal employee is hired to work a recurring, annual period that spans from January 15 to March 15. This is considered a three-month season because the period includes three consecutive months (January, February, and March).

How is eligibility determined for seasonal employees?

Employee eligibility for the employer contribution toward PEBB benefits is determined in accordance with Title 182 WAC and any additional policies, procedures, or written guidance issued by the PEBB Program.

PEBB participating employer groups may have different eligibility criteria, if approved by the PEBB Program (PEBB Policy 90-3). Any approved criteria will be outlined in Appendix A of your organization's Interlocal Agreement.

Establishing eligibility for the employer contribution upon hire

Newly hired seasonal employees who, based on the employer's knowledge, will likely return the next season, are eligible from their date of employment (typically the first day of work) if the employer anticipates they will work the following during their first season (Policy 15-1 and WAC 182-12-114(2)):

• An average of at least eighty hours per month,
• At least eight hours in each month, and
• For at least three consecutive months of the season.

When anticipating an employee's work hours:

• Only include the hours an employee is anticipated to actually work. Do not include holiday or leave hours. Unless required under federal law, an employer cannot use leave hours in calculating how many hours an employee works when establishing eligibility for a seasonal employee.
• Combine (stack) the hours and consecutive months worked from all positions or jobs (except faculty) within one employer.

What hours are excluded when determining eligibility?

The following hours must be excluded when anticipating an employee's work hours to determine eligibility:

• Standby hours and temporary increases in work hours, of 6 months or less, of 6 months or less, caused by training or emergencies (except governor-declared emergencies) that have not been or are not anticipated to be part of the employee's regular work schedule or pattern.
  • Standby hours are determined by the employer.
  • Employers must request the PEBB Program's approval to include temporary training or emergency hours when determining eligibility.

Employees may or may not receive benefits in their first season

If an employee meets the eligibility criteria listed above, and the employee is anticipated to work (PEBB Policy 15-1):

• Between 3 and 6 consecutive months and is not anticipated to return the next season, the employer has the option to provide benefits upon hire.
• Between 3 and 6 consecutive months and is anticipated to return the next season, the employer must provide benefits upon hire.
• For more than 6 consecutive months, regardless of whether the employer anticipates the employee will return each season, the employer must provide benefits upon hire.

Employees determined to be eligible for PEBB benefits

Employees determined to be eligible for PEBB benefits have 31-days after the date they become eligible to elect PEBB benefits by submitting enrollment forms and dependent verification documents (if applicable) to their benefits administrator (BA). However, eligible employees must have no less than ten calendar days after the date of receiving notice to elect coverage.

Learn about when benefits begin and the requirements and processes for enrolling newly eligible employees.

Employees determined to be ineligible for PEBB benefits

Employees who do not meet the eligibility criteria listed above may establish eligibility through stacking hours or may become eligible at a later date if the employer revises their anticipated work pattern or based on their work pattern.

Use the B-1 worksheet to track their work hours each month in case they become eligible based on work pattern. When using the B-1 worksheet, only include the hours an employee actually worked or is anticipated to work. Do not include holiday or leave hours.

• Holiday hours are not considered hours worked.
• L​​​​​​eave hours, unless required under federal law, do not count toward or add to an employee's work hours for the purpose of determining eligibility because they are replacing hours that the employee was already anticipated to work.

Establishing eligibility through stacking work hours or based on work pattern

Establishing eligibility through stacking work hours

Employees may "stack" or combine hours worked in more than one position or job within one employer to establish eligibility and maintain the employer contribution toward PEBB benefits.

Employees must notify their employer if they believe they are eligible through stacking. They become eligible through stacking when they meet the requirements described above and in Policy 15-1 and WAC 182-12-114(2).

Stacking includes work situations in which employees:

• Work two or more positions or jobs at the same time (concurrent stacking), or
• Move from one position or job to another (consecutive stacking) or
  • An employee may not consecutively stack hours when there is a break in PEBB benefits.
• Combine hours from a seasonal position with hours from a nonseasonal position or job.

  • Employees combining seasonal and nonseasonal hours maintain eligibility each month in which they are in pay status eight or more hours per month.

Complete and provide the A-2 worksheet to employees who are determined eligible through stacking.

Establishing eligibility based on work pattern

Newly hired employees determined to be ineligible for the employer contribution may establish eligibility at a later date:

• Upon revision of anticipated work pattern
  • If the employer revises an employee's anticipated work hours or anticipated duration of employment such that the employee meets the eligibility criteria for PEBB benefits, the employee becomes eligible when the revision is made.
• Based on work pattern (hours worked)
  • An employee who is determined to be ineligible, but later works an average of at least 80 hours per month, for at least eight hours in each month, and for more than six consecutive months becomes eligible the first of the month following the six-month averaging period.

Complete and provide the B-1 worksheet to existing employees who were not initially determined to be eligible but who later establish eligibility.

How do employees maintain eligibility for the employer contribution?

Seasonal employees who have established eligibility for benefits maintain eligibility in any month of the season in which they are in pay status eight or more hours during that month (WAC 182-12-131 (2)).

"Pay status" means all hours for which an employee receives pay.

Eligible employees leaving work for the off-season

Complete and provide the C-4 worksheet to employees when it is determined they are leaving work for the off-season.

Employees who work a season of less than nine months

Employees who work a season of less than nine months are not eligible for the employer contribution toward PEBB benefits during the off-season.

PEBB benefits end (for the employee and their enrolled dependents) the last day of the month in which the employee lost eligibility for the employer contribution or the last day of the month in which the premium and applicable premium surcharges were paid, whichever is later (WAC 182-12-131 and PEBB Policy Addendum 19-1A).

Benefits administrators (BAs) must terminate the employee's PEBB benefits when they are no longer eligible.

Learn more about when eligibility for benefits ends.

Continuing PEBB benefits during the off-season

Seasonal employees who are not eligible for the employer contribution during the off-season may continue the following benefits for a maximum of 12 months between periods of eligibility by enrolling in PEBB Continuation Coverage (Unpaid Leave) and self-paying the premium:

• Any combination of medical or dental coverage
• Life insurance
• Accidental death and dismemberment (AD&D)
  • If life or AD&D insurance is elected, both basic life and basic AD&D must be continued.
• Medical or Limited Purpose Flexible Spending Arrangements (FSAs)

Seasonal employees who do not return to work within a 12-month period may continue medical, dental, or both (but not life or AD&D) for the remaining six months allowed under federal COBRA (up to a total of 18 months).

Learn more about PEBB Continuation Coverage.

Employees who work a season of nine months or more

Employees who maintain eligibility in each month of a season of nine months or more are eligible for the employer contribution through the off-season, up to a maximum of three calendar months.

• Eligibility may not exceed a total of twelve consecutive calendar months for the combined season and off-season (PEBB policy 15-1).
  • For example, if a seasonal employee works an 11-month season, they are eligible for the one remaining month of the off-season only (not three months).
• Employees whose season becomes 12 months or more no longer meet the definition of a seasonal employee and are not eligible through the off-season.
  • For example, if a seasonal employee works a 10-month season and is extended for another 2 months, they have worked for 12 consecutive months and are not eligible during the off-season.

When the employment relationship is terminated after a season of nine months or more, and the employee is not anticipated to return the following season, they are no longer eligible for the employer contribution. Learn more about when eligibility for benefits ends.

Collecting the employee contribution during the off-season

When an employee is eligible for the employer contribution toward PEBB benefits during the off-season, make arrangements (with the employee) for the collection of the employee contribution during the off-season.

Learn more about paying for benefits.

Returning for the second consecutive season and beyond

Complete and provide the A-2 worksheet to employees who are returning for the second consecutive season who were not eligible during the first season.

Complete the D-5 worksheet for employees who are returning to work from an off-season in which they were not eligible for the employer contribution.

Establishing eligibility for the second season and beyond

Seasonal employees who return for a second consecutive season at the same employer are presumed to return each subsequent season (PEBB Policy 15-1).

Employees returning for their second consecutive season and beyond, to perform similar work with the same employer, are eligible each month in which they have eight hours of pay status, if they are anticipated to work:

• An average of at least eighty hours per month,
• At least eight hours in each month, and

• For at least three consecutive months of the season.

Include training hours when employees return prior to their next season to receive training. The training must be anticipated to be part of the employee's regular work schedule or pattern and the training month(s) must be consecutive to the employee's season.

• For example, if this year's season is from March to June and employee returns to work with:
  • 10 hours of training in February, the employee will regain eligibility in February.
  • 10 hours of training in January, the employee will regain eligibility in March, as there was a one-month gap between the training month (January) and the month in which the employee returns to the next season (March).
  • 7 hours of training in February, the employee will regain eligibility in March, as the employee did not have eight or more hours of pay status in February.

Employees determined to be eligible for the employer contribution

Employees who regain eligibility for PEBB benefits have 31-days after the date they become eligible to elect PEBB benefits by submitting the appropriate PEBB Employee Enrollment/Change form to their benefits administrator (BA). However, eligible employees must have no less than ten calendar days after the date of receiving notice to elect coverage.

The following benefits begin the first day of the month the employee is in pay status of eight or more hours (WAC 182-08-197(3)):

• Medical
• Dental
• Basic life and basic accidental death and dismemberment (AD&D)
• Employer-paid long-term disability (LTD)

Supplemental life and AD&D insurance

• Employees who self-paid for supplemental life insurance and/or supplemental AD&D insurance between periods of eligibility will maintain that level of coverage, effective the first day of the month in which the employee is in pay status eight or more hours.
• Employees who were eligible to continue supplemental life and AD&D insurance by self-paying the premium, but discontinued that coverage, must submit Evidence of Insurability (EOI) to MetLife for approval to enroll. MetLife will initiate the EOI process once the employee's enrollment request has been received via the MetLife Enrollment/Change form or through MetLife's My Benefits portal.

Employee-paid LTD insurance

• Employee-paid LTD is reinstated at the same coverage level the employee had prior to losing eligibility. Employee-paid LTD is effective the first day of the month the employee is in pay status of eight or more hours.
  • Employees who were not enrolled under the new LTD benefit design, which was effective January 1, 2022, when they lost eligibility are automatically enrolled in employee-paid LTD at the 60-percent coverage level.

Employees may reduce to the 50-percent coverage level or decline employee-paid LTD at any time by submitting the LTD Enrollment/Change form to their BA.

Seasonal employees who work a season with a duration of less than nine months are not eligible for employee-paid LTD.

These employees are eligible for employer-paid LTD but employee-paid LTD must be changed to "ineligible" in Benefits 24/7

Employees determined to be ineligible for the employer contribution

Employees who are determined to be ineligible may be eligible through stacking hours or may become eligible at a later date if the employer revises their anticipated work pattern or based on their work pattern.

Use the B-1 worksheet to track the work hours of ineligible employees each month in case they become eligible based on work pattern.

Transferring from one PEBB employer to another

Employees are considered a "transfer" when they move from one PEBB employer to an eligible position with another PEBB employer without a break in PEBB benefits. A break in PEBB benefits is one month or more in which an employee does not receive the employer contribution.

The table below provides examples to assist in determining if an employee has a break in PEBB benefits.

See below for guidance on employees who are and are not considered a "transfer".

Employees who do not experience a break in PEBB benefits (transfers)

Employees who move from one PEBB employer to another without a break in benefits, and are eligible in their new position:

• Are considered a transfer (not newly eligible), and
• Cannot make new benefit elections (their benefit elections remain the same).
  • Employees may be allowed to make changes if a qualifying special open enrollment event occurs.

Exception

Employees transferring from an employer group that offers medical-only benefits to an employer who offers full-benefits (medical, dental, life and AD&D, and LTD) will be allowed to make new elections for all benefits, except medical.

Complete the A-5 worksheet for incoming and outgoing employee transfers.

Employees who experience a break in PEBB benefits

Employees who move from one PEBB employer to another with a break in benefits, and are eligible in their new position:

• Are considered newly eligible, and
• Must make new benefit elections within 31-days of becoming eligible.

Complete the A-2 worksheet to determine and provide required notice of eligibility.

Related rules and policies

WAC 182-12-109: Definitions

WAC 182-12-113: What are the obligations of a state agency (employer) in the application of employee eligibility?

WAC 182-12-114: How do employees establish eligibility for PEBB benefits?

WAC 182-12-131: How do eligible employees maintain the employer contribution toward PEBB benefits?

WAC 182-12-142: What options for continuation coverage are available to faculty and seasonal employees who are between periods of eligibility?

WAC 182-08-197: When must a newly eligible employee, or an employee who regains eligibility for the employer contribution, elect PEBB benefits and complete required forms?

PEBB Policy 11-1: Providing a notice to an employee

PEBB Policy 15-1: Determining eligibility for a seasonal employee and maintenance of the employer contribution through the off-season

PEBB Policy Addendum 19-1A: Termination due to loss of eligibility or enrollment error