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Covering Dependents
Are my family members
eligible?
Are there additional forms required to enroll my dependents?
One of my children attends college. Can I still enroll in a
managed-care plan not offered in the county where he/she goes to
college?
If I die, can my surviving dependents continue PEBB coverage?
What happens if my covered family member is no longer eligible?
Can my dependent continue coverage if he or she is not longer
eligible under PEBB rules?
What should I do if my spouse or qualified same-sex domestic
partner is also eligible for PEBB coverage as an employee?
Premiums Paid With
Pretax Dollars
You may pay health plan premiums with pretax dollars.
Internal Revenue Service code Section 125 allows us to deduct
money from your paycheck before certain payroll taxes and your
income tax are calculated. This rule allow for deductions
including monthly premiums for your medical coverage and for the
state's dependent care program.
Why should I pay my monthly health care premiums with pretax
dollars?
Do I
need to sign up for a Section 125 deduction?
Can I change my mind about participating in a Section 125
deduction?
When would it benefit me not to have a Section 125 deduction?
Providers
How do I know if my doctor or hospital belongs to a plan?
May
I change providers after I have joined a plan?
Do all members of my family have to use the same provider?
If I want the freedom to see any doctor or health care provider
without a primary care provider referral, which plan should I
enroll in?
Making Changes
Who should I contact if I have a change of address?
May I waive my dependent's coverage during the year?
How do I enroll a new spouse or qualified same-sex domestic
partner or child?
Coordination of
Benefits
How does my PEBB coverage work with my other group medical or
dental coverage?
PEBB/HCA
Administration
Who
determines what PEBB benefits will be?
Who administers the day-to-day operations of these programs?
Are my family members
eligible?
If you are enrolling
yourself, you may also enroll your legal spouse or qualified
same-sex domestic partner and eligible children.
Are there additional forms required to enroll my dependents?
You must complete a
certification form if you want to add any of the following:
A spouse or
qualified same-sex domestic partner
A student over age
19
A dependent over
age 19 with a disability
An extended (legal)
dependent
One of my children attends college. Can I still enroll in
a managed-care plan not offered in the county where he or she
goes to college?
Yes. If our
dependent(s) lives outside your plan's service area temporarily
while attending an accredited secondary school, college,
university, vocational school, or school of nursing, he or she
may receive benefits through any licensed provider. Claims for
those providers will be paid as if the service had been received
through plan-designated providers. Refer to your plan's
certificate of coverage (COC) for details. Your dependent will
be responsible for the same co-payments or coinsurance amounts
that apply to enrollees who receive services in their plan
area. However, the plan must authorize routine care and all
other services in advance, except when emergency or urgent care
is needed.
If I die, can my surviving dependents continue PEBB coverage?
Yes. Dependents who
waived coverage prior to your death must complete the
appropriate enrollment form within 60 days after your
death to either enroll in or continue to waive coverage.
What happens if my covered family member is no longer eligible?
You, your dependent,
or your beneficiary must report eligibility changes such as
death, divorce, or when a dependent is no longer eligible as
defined in Washington Administrative Code (WAC) 182-12-260 to
the Health Care Authority within 60 days after the
change.
Can my dependent continue coverage if he or she is no longer
eligible under PEBB rules?
It depends on the
reason he or she lost eligibility. Please contact the Benefits
Department.
What should I do if my spouse or qualified same-sex domestic
partner is also eligible for PEBB coverage as an employee?
PEBB does not allow
dual coverage. Enrolled family members may be listed under one
account, but not both. This means you could waive the medical
coverage on your account and enroll on your spouse's or
qualified same-sex domestic partner's account, or enroll under
separate accounts. You will need to coordinate with your spouse
or qualified same-sex domestic partner to decide who will cover
any eligible dependent children.
Why should I pay my monthly health care premiums with pretax
dollars?
While the difference
is not very noticeable, you take home more one, because taxes
are calculated after the premium is deducted. By paying for our
coverage this way, you reduce your taxable income, which lowers
your taxes and saves you money.
Do I
need to sign up for a Section 125 deduction?
No. Your health care
premiums will be automatically deducted from your earnings
before taxes are calculated unless you sign the Section
125 waiver form saying you do not want to pay your premiums with
pretax earnings. The waiver form is available in the
Benefits department.
Can I change my mind about participating in the Section 125
deduction?
Yes, but only during
the annual open enrollment period and when there is a change in
your family circumstances, such as:
When would it benefit me not to have a Section 125 deduction?
If you have your
health plan premiums deducted before your taxes are calculated,
the following benefits may also be affected:
Social Security - If
your base salary is under the $98,400 per year maximum, Section
125 participation will same you money now my reducing your
social security taxes. However, if you are nearing retirement
age, your lifetime social security benefit would be calculated
using the lower salary
Unemployment
compensation - Section 125 also reduces the base salary used to
calculate unemployment compensation.
To waive your Section
125 option, complete the waiver form and return it to your
Benefits department.
How do I know if my doctor or hospital belongs to a plan?
You must call the
plan directly. For medical or dental plans, refer to the
phone directory. When you call the plan, be sure to mention
that you are a PEBB state of Washington enrollee.
You may also search
for providers, hospitals, and pharmacies that contract with the
medical plans you're interested in at the online provider
directory at
www.pebb.hca.wa.gov. If a provider is listed, call the
medical plan(s) to confirm his or her participation.
May
I change providers after I have joined a plan?
Yes, although rules
vary from plan to plan. Call your plan directly for details.
Do all members of my family have to use the same provider?
They can select the
same provider, but it's not required. Each dependent may select
his or her own provider available through the plan.
If I want the freedom to see any doctor or health care provider
without a primary care provider referral, which plan should I
enroll in?
The Uniform Medical
Plan allows freedom of chose for all approved provider types.
Who
should I contact if I have a change of address?
You must contact your
Benefits office within 60 days after you move. If the
health plan you are enrolled in is no longer available to you,
please contact the Benefits department.
May
I waive my dependent's coverage during the year?
Yes. You may waive
coverage for your dependent at any time during the year.
However, if your dependent needs to re-enroll in PEBB coverage,
please contact the Benefits department.
How do I enroll a new spouse or qualified same-sex domestic
partner or child?
You must submit a
revised Employee Enrollment/Change form and the
appropriate dependent certification form to the Benefits
department within 60 days of the date your dependent
became eligible for PEBB coverage. Otherwise, you must wait
until the next open enrollment period to enroll your dependents.
How does my PEBB coverage work with my other group medical or
dental coverage?
If you are also
covered through your spouse's or qualified same-sex domestic
partner's employer-provided health coverage, call the medical
and/or dental plans directly to ask how they will coordinate
benefits. Coordinating your plan with your spouse's plan may
save you money.
Who
determines what PEBB benefits will be?
The Legislature
establishes how much money is available to spend on benefits.
Then the Public Employees Benefits Board (PEBB) - a division of
the Health Care Authority (HCA) - establishes eligibility
requirements and approves the benefits plans of all
participating insurance companies. The Board meets regularly to
review benefit and eligibility issues and plan for the future.
Who administers the day-to-day operations of these programs?
The HCA purchases and
administers benefits within the amount funded by the
Legislature. The HCA contracts with health plans and manages
its own self-insured plans - the Uniform Medical Plan and
Uniform Dental Plan, to provide a choice of quality health care
options and responsive customer service to its members. |
