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The Public Employee Benefits Board (PEBB) has amended the eligibility rules for school employees effective January 1, 2001.
Employees interested in this issue should contact the Health Care Authority (the PEBB administrator) at 1-800-200-1004 or www.wa.gov.hca with their questions and ask for the “Retiree Enrollment Guide, Effective January 1, 2001, Understanding Your Medical & Dental Coverage.”
The following information was provided by the Health Care Authority:
Changes to Retiree Eligibility Effective 1-1-2001
On May 23, 2000 the Public Employees Benefits Board approved two changes to the administration of PEBB retiree insurance eligibility. They have been dubbed the “COBRA Bridge” and “Deferral” options. These two separate changes are highlighted below.
COBRA BRIDGE
Intent of the change is to facilitate a smooth transition from COBRA coverage into retiree coverage for those that qualify. Applicants must meet PEBB retiree eligibility requirements prior to the end of their COBRA period.
- Retiree’s are still required to meet retiree eligibility criteria outlined in WAC 182-12-117.
- Applicant’s enrollment window begins 60 days from the date COBRA coverage ends.
- Coverage is retroactive to the first of the month following the date the COBRA coverage ended.
- Proof of loss of continuous coverage during the COBRA period is required upon application for retiree insurance. Acceptable documents showing proof of loss include:
- Letter from the employer reflecting the name of individual(s) covered, the date coverage began, and the date coverage ended.
- Letter from the insurer reflecting the name of individual(s) covered, the date coverage began, and the date coverage ended.
- Certificate of Creditable Coverage
- The earliest insurance effective date available to individuals taking advantage of this enrollment opportunity is January 1, 2001.
- COBRA coverage may have started prior to January 1, 2001, however it may
not have ended prior to December 31, 2000.
Deferral of Retiree Insurance Enrollment
Intent of the change is to avoid duplication of group medical coverage for retiree’s who are eligible for employer sponsored group coverage attained by their reemployment or the current employment of a spouse. The prior rule only allowed for deferring or waiving of retiree coverage if the other group coverage was PEBB or Washington State school district sponsored coverage.
The new rule is broader, in that it is no longer limited to PEBB or Washington State school district sponsored coverage. The term “Group Coverage” is defined as coverage that is attained by current active employment and does not include COBRA or other group retiree programs.
- Retiree must qualify as a PEBB retiree at the time they leave their own active employment, by meeting all requirements outlined in WAC 182-12-117.
- Retiree’s can defer/waive their enrollment in a PEBB plan while enrolled in employer- sponsored coverage due to their employment.
- Waiver must be submitted in writing to HCA. The earliest date for waiving coverage is January 1, 2001 with a coverage end date of December 31, 2000.
- New retiree’s will need to complete a retiree application form reflecting their desire to waive coverage (a waiver section will be added to the ongoing form).
- Retiree’s may defer/waive their enrollment in a PEBB plan while enrolled on employer- sponsored coverage as a dependent, due to their spouses’ active employment.
- Application for PEBB retiree coverage reflecting their desire to waive coverage must be made within 60 days of active group coverage ending (a waiver section will be added to the ongoing form).
- Proof of loss of continuous coverage is required upon application for retiree insurance.
- Coverage is retroactive to the first of the month following the date the active group coverage ended.
The above information is provided to you as a courtesy by the VEBA Trust. It was provided by the Health Care Authority.
About VEBA
Founded in 1984, the non-profit Trust for Public Employees in the State of Washington offers tax-free medical expense reimbursement plans to eligible employers. The Trust currently provides benefits to over 14,000 employees statewide and Trust assets exceed $57,000,000. The Trust offers members three investment fund choices.
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