Faculty

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 upon hire and when an employee experiences a change in eligibility (PEBB Policy 11-1). The notice should be provided within a reasonable time frame as part of the hiring process.

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

Eligibility worksheets

• Use the A-3 worksheet for newly hired faculty, including those who are transferring from another PEBB employer with a break* in PEBB benefits or who are returning after 12 months of losing eligibility for the employer contribution.
• Use the A-5 worksheet for newly hired faculty who are transferring from another PEBB employer without a break* in PEBB benefits.
• Use the B-2 worksheet for existing faculty who were not initially determined to be benefits-eligible when hired on a quarter-to-quarter or semester-to-semester basis, and are now anticipated to work a second consecutive quarter or semester or who have a change in work pattern that requires review.
  • The B-2 is also used to track workloads of ineligible faculty in case eligibility is established based on work pattern.
• Use the B-2a worksheet for faculty hired on a quarter-to-quarter or semester-to-semester basis, who meet the requirements to maintain eligibility for the next quarter or semester.
• Use the B-3 worksheet for faculty hired on a quarter-to-quarter or semester-to-semester basis, who are requesting if they are potentially eligible to receive the uninterrupted employer contribution for an academic year through two-year averaging.
• Use the B-3a worksheet for determining if faculty hired on a quarter-to-quarter or semester-to-semester basis, meet requirements to maintain eligibility through a two-year averaging review.
• Use the C-3 worksheet for faculty hired on a quarter-to-quarter or semester-to-semester basis, who are leaving work for a summer, off-quarter, or off-semester.
• Use the D-3 worksheet for faculty who are returning to a faculty position within 12 months of losing eligibility for the employer contribution.
• Use the D-6 worksheet for instructional year faculty who retire and then return to a quarter-to-quarter or semester-to-semester faculty position within 12 months of losing eligibility for the employer contribution due to retirement.

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 faculty defined?

Faculty are academic employees of an institution of higher education whose workload is not defined by work hours but whose appointment, workload, and duties directly serve the institution's academic mission, as determined under the authority of its enabling statutes, its governing body, and any applicable collective bargaining agreement (WAC 182-12-109).

How is eligibility determined for faculty?

Faculty 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.

Establishing eligibility for the employer contribution upon hire

Newly hired faculty are eligible from the date of employment (typically the first day of work) if the employer anticipates they will work (WAC 182-12-114(3)):

• Half-time or more, and

• For the entire instructional year (or equivalent 9-month period).

"Half-time" means one-half of the full-time academic workload as determined by each institution, except that half-time for community and technical college faculty employees is governed by RCW 28B.50.489 (1) and (2).

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.
• Combine (stack) the hours and consecutive months worked from all faculty workloads.

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, caused by training or emergencies (except governor-declared emergencies) that have not been or are not anticipated to be part of the faculty'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.

Faculty determined to be eligible for PEBB benefits

Faculty 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 faculty 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.

Faculty determined to be ineligible for PEBB benefits

Faculty who do not meet the eligibility criteria listed above may establish eligibility through stacking hours or may become eligible at a later date.

Establishing eligibility through stacking work hours

Faculty may "stack" or combine hours worked as a faculty member at more than one institution of higher education to establish eligibility and maintain the employer contribution toward PEBB benefits.

Faculty workloads may only be stacked with other faculty workloads to establish and maintain eligibility.

Faculty 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 WAC 182-12-114(3).

Complete and provide the A-3 worksheet to faculty who are determined eligible through stacking.

Establishing eligibility at the start of the second consecutive quarter or semester

Faculty hired on a quarter-to-quarter or semester-to-semester basis, who the employer anticipates will not work for the entire instructional year (or equivalent nine-month period), are eligible at the beginning of the second consecutive quarter or semester of employment in which they are anticipated to work, or has actually worked, half-time or more.

Spring and fall are considered consecutive quarters/semesters when first establishing eligibility for faculty that work less than half-time during the summer quarter or semester.

• Medical (with vision), dental, basic life and AD&D, and employer and employee-paid LTD insurance begin the first day of the month following the beginning of the second consecutive quarter or semester of half-time or more employment. If the first day of the second consecutive quarter or semester is the first working day of the month, then coverage begins at the beginning of the second consecutive quarter or semester.
• Supplemental life and AD&D insurance begin the first day of the month following the date the contracted vendor receives the required form or approves the enrollment.

Complete and provide the B-2 worksheet to existing faculty who were not initially determined to be eligible but who establish eligibility at the beginning of the second consecutive semester.

Use the B-2a worksheet to determine if faculty will maintain eligibility for the next quarter or semester. If the next quarter/semester is the faculty member's summer or off-quarter/semester, complete the C-3 worksheet.

Establishing eligibility based on revision of work pattern

Newly hired employees determined to be ineligible for the employer contribution may establish eligibility upon revision of anticipated work pattern.

If the employer revises a faculty member's anticipated workload after the beginning of the anticipated work period (quarter, semester, or instructional year), such that they meet the eligibility criteria for PEBB benefits, the faculty member becomes eligible when the revision is made.

Complete and provide the B-2 worksheet to existing faculty who were not initially determined to be eligible but who later establish eligibility based on work pattern. Use the B-2a worksheet to determine if faculty maintain eligibility for the next quarter or semester.

How do faculty maintain eligibility for the employer contribution?

Eligible faculty who are anticipated to work half-time or more for the entire instructional year (or equivalent nine-month period) maintain eligibility for the employer contribution toward PEBB benefits each month of the instructional year (WAC 182-12-131 (3)).

Eligible faculty hired on a quarter-to-quarter or semester-to-semester basis maintain eligibility each quarter or semester in which they work half-time or more.

Faculty may also maintain eligibility through two-year averaging or during the summer or off-quarter/semester.

Maintaining eligibility through two-year averaging

Faculty hired who worked an average of half-time or more in each of the two preceding academic years, are potentially eligible to receive the uninterrupted employer contribution toward PEBB benefits through two-year averaging.

"Academic year" means summer, fall, winter, and spring quarters or summer, fall, and spring semesters and begins with the summer quarter or semester.

To establish or regain eligibility through two-year averaging, faculty must provide written notification of their potential eligibility to their employer (or employers if stacking hours) within the deadlines established by the employer(s) and they must:

• Be hired on a quarter-to-quarter or semester-to-semester basis, and
• Have worked at least two quarters or two semesters at one or more institution of higher education, and
• Worked an average of half-time or more for three quarters or two semesters in each year of the two preceding academic years.

Complete and provide the B-3 worksheet to faculty requesting if they are potentially eligible through two-year averaging.

If eligible, they continue to receive the uninterrupted employer contribution for each academic year in which they are employed on a:

• Quarter-to-quarter basis and work at least two quarters and have an average workload of half-time or more for three quarters, or
• Semester-to-semester basis and work at least two semesters and have an average workload of half-time or more for two semesters.

Use the B-3a worksheet to review eligibility for two-year averaging and when there has been a change in work pattern that requires review.

Eligibility under two-year averaging ends immediately if the eligibility criteria is not met or becomes impossible to meet. Faculty who lose eligibility for two-year averaging may be eligible on a quarter-to-quarter or semester-to semester basis or may be eligible for summer or off-quarter/semester benefits.

Maintaining eligibility during the summer or off-quarter/semester

Faculty who are leaving work for the summer or off-quarter/semester may maintain eligibility for the employer contribution during one summer or off-quarter/semester per 12-month period.

To be eligible during the summer or off-quarter/semester:

• The employer must anticipate they will likely return to a faculty position following the summer or off-quarter/semester, and
• They must have worked an average of half-time or more throughout the entire instructional year (or equivalent nine-month period), and
• Worked in each quarter or semester of the instructional year.

Faculty who return to work a second consecutive instructional year (or equivalent nine-month period) are presumed to return after the off-quarter/semester (PEBB Policy 17-3).

Complete and provide the C-3 worksheet to faculty who are leaving work for the summer or off-quarter/semester.

If eligible, make arrangements with faculty to collect the employee premiums due while they are off for the summer or off-quarter/semester. Learn more about paying for benefits.

If employment ends and the employer has no anticipation they will be returning as faculty at any institution of higher education where the employee has employment, eligibility toward summer or off-quarter/semester PEBB benefits ends on the end date specified in the termination notice or resignation letter, whichever is earlier. If the employer deducted the employee premium after they were no longer eligible, PEBB benefits end the last day of the month for which employee premiums were deducted (PEBB Policy Addendum 19-1A).

Faculty between periods of eligibility

Faculty who are between periods of eligibility may continue any combination of medical or dental and may also continue life insurance and accidental death and dismemberment (AD&D) insurance for a maximum of 12 months by enrolling in PEBB Continuation Coverage (Unpaid Leave) and self-paying the premium.

Learn about PEBB Continuation Coverage (Unpaid Leave) on the Public employees website.

Returning to a faculty position within 12 months of losing eligibility

Faculty who have lost eligibility for the employer contribution toward PEBB benefits, will regain eligibility the first day of the month in which the quarter or semester begins if they:

• Return to a faculty position,
• Are anticipated to work half-time or more for the quarter or semester, and
• Return no later than 12 months after the month in which they lost eligibility.

Complete and provide the:

• D-3 worksheet to faculty who are returning within 12 months of losing eligibility.
• D-6 worksheet for faculty who return within 12 months after retiring.
• A-3 worksheet if returning more than 12 months after losing eligibility.

Transferring from one PEBB employer to another

Employees, including faculty, 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 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

Faculty 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-3 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 17-1: Determining faculty eligibility for summer/short class sessions

PEBB Policy 17-3: Determining faculty eligibility for off-quarter/semester or for decreases in workload

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