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Information for Employer Groups
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Things to Know About Participating in the PEBB Program

Group Participation

  • PEBB participation is available to entities defined in WAC 182-12-111, including employee organizations, blind vendors, local governments, K-12 school districts and educational service districts, and tribal governments. As well, specific agencies or instrumentalities of employer groups may participate apart from the larger employer group.
  • The PEBB group coverage is available to your entire group, groups of bargaining unit employees or all non-represented employees.
  • The group may request inclusion of their current retirees covered under their current retiree health plan subject to PEBB requirements outlined in WAC 182-12-175.
  • Employees retiring after the group joins PEBB will be eligible for PEBB retiree coverage subject to retiree eligibility rules in WAC 182-12-171.
  • Coverage for retirees ONLY is not available through PEBB.
  • The group may purchase the full package of medical/vision, dental, life, and long-term disability, or may purchase only medical/vision. (Note: If the group selects the full benefits package, employees cannot waive dental coverage.)
  • Participation is subject to approval by the Health Care Authority (HCA).
  • Once approved, a start-up fee will be assessed to each group based on size and a signed Interlocal or Intergovernmental Agreement will be required. Failure to pay the start-up fee or return the Agreement prior to the group's effective date of coverage may result in a delayed coverage date.
  • Once approved, the group must maintain its PEBB coverage for one full year and may leave only at the end of a plan year.

Application Requirements

For groups with 100 or more employees, at least 120 days prior to the requested effective date, the group must submit a letter of application to:

Steve Norsen, Manager
PEBB Outreach and Training
Health Care Authority
P.O. Box 42684
Olympia, WA 98504-2684

Groups with less than 100 employees may submit their letter of application 90 days prior to the requested effective date.

Please include the following items:

  1. A letter of application
  2. A reference to the Revised Code of Washington (RCW) statute governing your agency
  3. A resolution from your governing body (see sample)
  4. Which employee group(s) will be joining (e.g., all employees, bargaining unit(s) or all non-represented.) If joining as separate agenc(ies) or instrumentalit(ies), indicate the organizational structure of the group(s) joining.
  5. Signed Government Function Attestation document that attests to the fact that the employees and all departments or agencies of the applying group fulfill government functions.
  6. W-9 form with your group’s Taxpayer Identification Number (TIN)
  7. Whether you are requesting inclusion of currently covered retirees.
  8. Which benefit package the group is purchasing, medical/vision or the full package of medical/vision, dental, life, and long-term disability
  9. Documentation on your current coverage including:
    • A copy of the most recent employee benefits booklet describing the current plan of benefits (if health maintenance organizations [HMOs] are offered, a copy of the most recent multiple or dual choice brochure must also be included)
    • Previous three years' rate history for all indemnity plans and HMOs, including a narrative history of any benefit modifications and their effective dates during the same three-year period
    • Previous three years' monthly employee eligibility numbers by plan
  10. Current employee census of all eligible employees including:
    • Age and gender of employees and all dependents.
    • Current percentage of time or number of hours worked each week per eligible employee
    • Current employee census of those covered under each retirement program
  11. Current retiree census (if applicable) including:
    • Age, gender, and family size
  12. Relevant bargaining language, if the
    • Bargaining agreement or terms of employment stipulate employee eligibility that differs from PEBB employee eligibility as outlined in WAC 182-12-115.
    • Typically, only a difference in length of waiting period to establish eligibility effective date will be considered for approval by HCA.
  13. A copy of current benefit eligibility rules
  14. Incomplete applications will only be held for 60 days from the initial submission date before the group must resubmit their request for participation and all appropriate documentation. The PEBB Outreach and Training Manager may approve a 30 day extension due to unusual circumstances. However, such extensions may result in a delayed participation effective date.

Additional requirements for employers with more than 100 employees

  1. Monthly experience data for the year-to-date and two previous policy years, showing monthly premium and claims for each plan and each coverage.
  2. Year-end experience accounting from the current insurer for the two previously completed plan years.
  3. A year-to-date analysis and two previous years' analyses of large claims (in excess of $50,000). For large claims in excess of $100,000, indicate if the claim is closed or on-going.

Employers with 100 or more employees who were former members of a multiple employer trust, making employer-specific data unavailable, may waive these three additional requirements.

Failure to submit the necessary documentation at least 120 days prior to the desired effective date of coverage may result in postponement of evaluation of the group's application.

Approval Process

HCA will review the group's application and notify the applicant of the determination.

Denied Applications

  • When an employer group is denied participation in the PEBB program, they will be notified in writing of the participation requirement(s) they did not meet.
  • Any entity or organization whose application to participate in PEBB benefits has been denied may appeal the decision to the PEBB appeals committee. The PEBB appeals manager must receive the notice of appeal within thirty days of the date of the denial notice. For more information on appeals, see WAC 182-16-038.
  • The group may re-apply for participation in the PEBB program when they feel that circumstances have changed sufficiently to allow them to meet all participation criteria.

New Group Start-up Fees

Group size
(includes employees and retirees)		 Fee
Less than 100 potential enrollees $10 per person
100 - 500 potential enrollees $1,500
501 - 700 potential enrollees $2,000
701 - 1,000 potential enrollees $2,500
More than 1,001 potential enrollees $4,000

Operational Information

  • Rates – Rates are set for a plan year – January 1 through December 31. Notification of new rates is sent to each group via email in the fall prior to the new rate effective date of January 1.
  • Monthly Billing – An invoice will be sent around the 25th of the month prior to the month of coverage. Payment in full is required by the 20th of the month of coverage. For example, around May 25th an invoice will be sent for June coverage. Payment in full for June coverage is due by June 20th.
  • Account Maintenance – Groups will be expected to maintain their own accounts. You will need to identify who within your agency will be responsible for “keying” account information into the PEBB Insurance System. The PEBB Outreach and Training staff will help facilitate this process and will provide your staff with the appropriate training.

Sample Resolution

A RESOLUTION OF THE (Governing Body) OF (Employer Group) REQUESTING APPROVAL BY THE HEALTH CARE AUTHORITY TO PARTICIPATE IN THE WASHINGTON STATE INSURANCE PLANS

WHEREAS, the Health Care Authority administers the medical, dental, life, and long term disability insurance coverage for the employees of the state of Washington, as set forth in chapter 41.05 RCW; and,

WHEREAS, the (Governing Body) representing the (Employer Group) has reviewed the state insurance plans, chapter 41.05 RCW, RCW 41.04.205, chapter 182-08 WAC, and chapter 182-12 WAC; and,

WHEREAS, we deem the state insurance plans as providing desirable insurance coverage for the employees (and members of the Governing Body where applicable); and,

WHEREAS, we certify that all employees (and members of the Governing Body) enrolled are eligible to participate in the state insurance plans;

BE IT RESOLVED, that the (Employer Group) requests approval by the Health Care Authority to participate in the state insurance plans for the employees of the (Employer Group), subject to the requirement of RCW 41.04.205 and the rules adopted thereunder.

DATED this _________________ day of ________________________, 2009.

____________________________________
(Name and title of Governing Body member)

Terminating Participation

  • Termination of participation in the PEBB program may be requested by the Group once they have met the participation requirements and in accordance with the Interlocal or Intergovernmental Agreement; Section 8, Termination.
    • Termination of PEBB coverage includes all employees, retirees, and individuals on COBRA, Leave Without Pay, or Extension of Coverage
  • The group must submit written notification of their intent to terminate participation in the PEBB program to the PEBB Outreach and Training Manager at least 60 days prior to the end of the plan year (December 31).
  • The Outreach and Training Manager will acknowledge the acceptance of the group’s termination in writing.
  • Notification of termination will be sent by the PEBB program to each individual employee and retiree.
  • Action will be taken by the PEBB staff to terminate all employee/retiree accounts in the PEBB insurance system.
  • A Certificate of Creditable Coverage will be sent to each individual after the termination action has been made in the insurance system.