Bookmark & ShareGeneral Information and Requirements
Updated 12/16/2008
To enroll a new employee in PEBB Benefits you must:
- Determine if the new employee is eligible for PEBB benefits (WAC 182-12-115)
- If the employee is eligible, determine the employee's initial eligibility date
- Determine the deadlines for enrollment (see table below)
Determine when the coverage for each of these will begin (28.6 KB)
Once the employee submits the enrollment forms:
- Verify all forms have been completed correctly
- Determine if all dependents being added to the coverage are eligible (WAC 182-12-260)
- Verify all necessary dependent certification forms have been submitted (i.e. spouse/qualified domestic partner, student, extended dependent, dependent with disabilities, and adult dependent)
- Determine if carrier approval is required for the requested amount of life insurance
| Employee must complete and return this form... | ...within... | ...or this will happen |
|---|---|---|
| Employee Enrollment Change form | 31 days of employee’s initial date of eligibility | Enroll only the employee in Uniform Medical Plan and Uniform Dental Plan |
| LTD Enrollment/Change form | 31 days of employee’s initial date of eligibility | Enroll the employee in Basic LTD coverage only |
| Life Insurance Enrollment form | 60 days of employee’s initial date of eligibility | Enroll the employee in Basic Life only |
| FSA and DCAP | 31 days of employee’s initial date of eligibility | Must wait for annual open enrollment to enroll for the next year or have a qualified event that triggers a special open enrollment. |
Is the employee eligible?- Determine New Employee Eligibility (1.1 MB)
- Date of Hire and Effective Dates (13.8 KB)
- 2009 Calendar (49.1 KB)
- Dual Enrollment
- Adult Dependents
Forms
Employee
- EE Enrollment/Change form (722.9 KB)
- EE Enrollment/Change form for medical only (378.3 KB)
Dependents
- Spouse/Domestic Partner Certification form (447.9 KB)
- Student Certification form (234.3 KB)
- Dependent w/Disabilities form (311.4 KB)
- Extended Dependent form (243.5 KB)
- Adult Dependent form (345.8 KB)
Life Insurance (see System Keying below for instructions on keying):
- Life Insurance Enrollment Form (139.5 KB)
Long-Term Disability:
- Long Term Disability Enrollment/Change Form (109.3 KB)
Other Forms: Pers/Pay forms page.
System Keying PAY1
Common Questions and Issues
WAC References
- 182-08-197 - 31 days to submit health forms, other deadlines
- 182-12-115 - Eligible Employees
- 182-12-260 - Eligible Dependents
