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How to Make Changes to Your Coverage

When can I make a change in my health plan outside of open enrollment?

Outside of our annual open enrollment, PEBB rules recognize certain events that allow you to make changes to your PEBB medical and dental plans midyear.

The following events qualify for a special open enrollment, allowing you to change your or your family's enrollment or health plan selection. The change in enrollment must correspond to the event that creates a special open enrollment for the subscriber, dependent(s), or both.

• When you marry or establish a Washington State-registered domestic partnership.
• After a birth, adoption, or placement for adoption of a child.
• When you acquire an eligible dependent through marriage, Washington State-registered domestic partnership, legal custody, or legal guardianship.
• When a child meets PEBB dependent eligibility criteria.
• When there has been a change in your or a dependent's employment status that affects your or your dependent's eligibility, level of benefits, or cost of insurance coverage.
• When you or a dependent loses comprehensive group health coverage.
• When you or a covered dependent changes residence, and the change affects your or your dependent's eligibility, health plan availability, level of benefits, or cost of insurance coverage.
• When your or your dependent's provider discontinues participation with your health plan, and a continuity of care issue exists with your or your dependent's ongoing treatment (only in specific situations).

If these events occur, you are required to update or change your account:

• When there is a divorce, annulment, or dissolution of a domestic partnership from a covered dependent.
• When you lose a covered dependent or a covered dependent's eligibility changes.
• When you move and your medical plan is no longer available in your county of residence.
• When you return to work as a seasonal employee.
• When you retire.
• When you or an eligible dependent becomes entitled to Medicare.
• When you, your spouse, or qualified/Washington State-registered domestic partner covered on your account receives a court order or medical support order to provide health coverage for an eligible dependent.
• When you or an eligible dependent receives notice from the Washington State Department of Social and Health Services that it is more cost-effective to enroll in the PEBB Program instead of a medical assistance program.

To make any change in benefits, you must notify the PEBB Program no later than 60 days of the date when one of these events occurs. Employees must contact their personnel, payroll, or benefits office to get and submit the correct form. Retirees, COBRA, and Leave Without Pay subscribers must contact the PEBB Program at 1-800-200-1004. All forms are available online.

When can I make Flexible Spending Account and Dependent Care Assistance Program changes?

To find out what qualifying events will allow you to enroll in or change your annual contribution for the state's flexible spending account or Dependent Care Assistance Program (DCAP), go to the ASIFlex website for details.

Things to remember

• You must enroll all eligible family members in the same medical and/or dental plan. (Exception: Adult dependents may enroll in a different health plan than the subscriber if the dependent does not reside within the subscriber's plan service area or the subscriber has waived or deferred medical coverage.) However, each family member may have a different doctor or other health care provider.
• If you have a specific doctor you want to stay with, you must contact your chosen medical plan to verify that he or she will contract with that plan to serve PEBB members.
• Even if your doctor, dentist, or health care facility no longer contracts with your plan, you may not change plans until the next open enrollment period or if you have a corresponding special open enrollment event.
• PEBB does not allow dual coverage. If you and your spouse or Washington State-registered domestic partner are eligible employees or retirees, you need to decide which of you will cover any eligible children on your medical and/or dental plan. An enrolled family member may be listed on one account, but not both. This means you could waive the medical coverage on your account and enroll on your spouse's or domestic partner's account.

Making changes to your coverage

If you are adding or removing a family member, complete and return an enrollment form. (This cannot be done online.)

What information should I read before making a change?

• Review the medical plan benefit comparisons.
• Read "Changes to Your 2010 Coverage."
• Review the 2010 rates. (School district and employer group employees need to contact their personnel, payroll, or benefits office to find their monthly premiums.)
• If you are interested in waiving medical coverage or if you have waived medical coverage in the past, read waiving coverage (for employees) or deferring coverage (for retirees).

What should I know about PEBB's dental plans?

Find how the different types of dental plans work and where the dental plans are offered.

Review the dental benefits comparison.

Want to know more about your plan choices?

If you still have questions, contact the plans.