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Information for K-12 School Districts and Educational Service Districts
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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 K-12 school districts and educational service districts. 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 nonrepresented employees
  • School districts and educational service districts must purchase the full package of medical/vision, dental, life, and long-term disability
  • Participation is subject to review for compliance with HCA terms and conditions of participation.
  • A start-up fee will be assessed to each group based on size. Failure to pay the start-up fee or return the signed Interlocal Agreement (55 KB) prior to the group's effective date of coverage may result in a delayed coverage date.

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
Phone: 1-800-700-1555
Fax: 360-923-2608

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 resolution from your governing body (see sample)
  3. 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.
  4. W-9 form with your group’s Taxpayer Identification Number (TIN)
  5. An estimate of the number of employees and dependants to be enrolled.
  6. Which employee group(s) will be joining (e.g., all, bargaining unit(s) or all non-represented)

Failure to submit the necessary documentation prior to the effective date of coverage may result in a delayed coverage effective date.

Approval Process

The HCA will review the application for compliance with HCA terms and conditions of participation.

Any 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.

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 – There are two components to this rate structure,
    1. The employer portion
      • Often times referred to as the base rate or composite rate is allocated by the Legislature and becomes effective July 1 of each year.
      • The employer portion is based on the Legislative allocation for State employees and may vary slightly from what is funded for School District employees.
      • K-12 School Districts and ESDs will see a rate change for the employer portion of the rate structure effective July 1 of each year. Notification of the rate change is sent via email to School Districts and ESDs in the spring, prior to July 1 effective date.
    2. The employee portion
      • Based on the employee’s selection of health plan and family size.
      • The employee portion of the rate structure is set for a plan year – January 1 through December 31.
      • Notification of the rate change is sent via email to School Districts and ESDs in the fall, prior to the January 1 effective date.
  • 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 (School District or Bargaining Unit) 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 (School District or Bargaining Unit) 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 (School District or Bargaining Unit) requests approval by the Health Care Authority to participate in the state insurance plans for the employees of the (School District or Bargaining Unit), 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 is outlined in the interlocal agreement.
    • Termination of PEBB coverage includes all employees, and individuals on COBRA, Leave Without Pay or Extension of Coverage
  • The group must submit written notification of their intent to terminate 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.
  • Action will be taken by the PEBB staff to terminate all employee 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.