Consequences of a Missed a Deadline

Posted on behalf of Sheryl Gordon

The state of Washington, through the PEBB Program provides medical, dental and other insurance coverage to state employees (that’s us folks)!    The PEBB Group in Olympia (Public Employee Benefits Board) works very hard to negotiate plans to keep you and your family healthy.  When you get an email from your HR Office that notifies you of eligibility for employer benefits, you should respond, because in the PEBB system not taking action can result in some unwanted consequences.  The following question from a current staff member illustrates this . . .

Question: I’m a newly eligible employee, but I have health coverage through another employer group.  I didn’t fill out or submit the health insurance forms you sent me by the “due date,” and the college defaulted me into the Uniform Plan and to the Smoker Surcharge, for which I now have to pay $84 + $25 per month and can’t make changes until next fall’s Open Enrollment.   I didn’t sign anything or give permission for you to do this.  Is this legal?

Answer:  The default for “non-response” is supported in both RCW and WAC. Here are the citations:

  • RCW 41.05.065(4) gives the PEBB board the authority to determine terms and conditions of employee and retired employee participation and coverage, including establishment of eligibility criteria subject to the requirements of RCW chapter 41.05.065.

 

  • RCW 41.05.065(8) states “Employees shall choose participation in one of the health care benefit plans developed by the board and may be permitted to waive coverage under terms and conditions established by the board.” Those terms and conditions include submitting a form within 31 days to choose to waive medical coverage.

 

  • WAC 182-08-197(1)(b) states “If a newly eligible employee’s employing agency does not receive the employee’s required forms indicating medical, dental and LTD elections and the employee’s tobacco use status attestation within 31 days and life insurance elections within 60 days of the employee becoming eligible, his or her enrollment will be as follows: (i) Uniform Medical Plan Classic; (ii) Uniform Dental Plan; (iii) Basic life insurance; (iv) basic long-term disability insurance; (v) Dependents will not be enrolled; and a tobacco surcharge will be incurred as described in WAC 182-08-185(1)(b).

 

As a state entity, we must follow state-mandated requirements (i.e. those outlined in the RCWs and WACs). Our office will continue to send out notifications in an effort to avoid missed deadlines, so please keep an eye out!

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