(Effective Until January 1, 2009.) WAC 182-12-260
Who are eligible dependents? The
following are eligible as dependents under the PEBB
eligibility rules:
(1) Lawful spouse.
(2) Domestic partner qualified by the PEBB declaration of
domestic partnership that meets all of the following criteria:
(a) Partners have a close personal relationship in lieu
of a lawful marriage;
(b) Partners are not married to anyone;
(c) Partners are each other's sole domestic partner and
are responsible for each other's common welfare;
(d) Partners are not related by blood as close as would
bar marriage; and
(e) Partners are barred from a lawful marriage.
(3) Domestic partner qualified by the certificate of
state registered domestic partnership or registration card
issued by the Washington secretary of state for a same-sex
partnership.
(4) Children through age nineteen. Children include:
(a) The subscriber's biological children, stepchildren,
legally adopted children, children for whom the subscriber has
assumed a legal obligation for total or partial support of a
child in anticipation of adoption of the child, children of
the subscriber's qualified domestic partner, or children
specified in a court order or divorce decree;
(b) Married children who qualify as dependents of the
subscriber under the Internal Revenue Code;
(c) Extended dependents in the legal custody or legal
guardianship of the subscriber, their spouse, or qualified
domestic partner. The legal responsibility is demonstrated by
a valid court order and the child's official residence with
the custodian or guardian. This does not include foster
children for whom support payments are made to the subscriber
through the state department of social and health services
foster care program;
(d) Children age twenty through age twenty-three who are
attending high school or registered students at an accredited
secondary school, college, university, vocational school, or
school of nursing.
(i) Student health plan enrollment begins the first day
of the month of the quarter or semester for which the child is
registered begins. Health plan enrollment ends the last day
of the month in which the student stops attending or in which
the quarter or semester ends, whichever is first, except that
dependent student eligibility continues year-round for those
who attend three of the four school quarters or two semesters.
(ii) Student eligibility for enrollment in a PEBB health
plan continues during the three month period following
graduation provided the subscriber is covered, the child has
not reached age twenty-four, and meets all other eligibility
requirements.
(iii) Student recertification occurs annually.
(e) Children as defined in (a) through (d) of this
subsection who have disabilities are eligible by subsection
(5) of this section.
(5) Children of any age with disabilities, developmental
disabilities, mental illness or mental retardation who are
incapable of self-support, provided such condition occurs
before age twenty or during the time the dependent was
eligible as a student under subsection (4) of this section.
(a) The subscriber must provide evidence that such
disability occurred as stated below:
(i) For children enrolled in PEBB insurance coverage, the
subscriber must provide evidence of the disability within
sixty days of the child's attainment of age twenty.
(ii) For children enrolled in PEBB insurance coverage as
a student under subsection (4)(d) of this section, the
subscriber must provide evidence of the disability within
sixty days after the student is no longer eligible under
subsection (4)(d) of this section.
(iii) To enroll a dependent child with disabilities, age
twenty or older, the subscriber must provide evidence that the
condition occurred before the child reached age twenty or
evidence that when the condition occurred the child would have
satisfied eligibility for student coverage under subsection
(4) of this section. The PEBB benefits services program will
request evidence of the child's disability periodically
thereafter.
(b) The subscriber must notify the PEBB benefits services
program, in writing, no later than sixty days after the date
that a child age twenty or older no longer qualifies under
this subsection.
(i) For example, children who become self-supporting are
not eligible under this rule as of the last day of the month
in which they become capable of self-support. The child may
be eligible to continue enrollment in a PEBB health plan under
provisions of WAC 182-12-270.
(ii) Children age twenty and older who become capable of
self-support do not regain eligibility under subsection (5) of
this section if they later become incapable of self-support.
(a) Parents covered under PEBB medical before July 1,
1990, may continue enrollment on a self-pay basis as long as:
(i) The parent maintains continuous enrollment in PEBB
medical;
(ii) The parent qualifies under the Internal Revenue Code
as a dependent of the subscriber;
(iii) The subscriber continues enrollment in PEBB
insurance coverage; and
(iv) The parent is not covered by any other group
medical.
(b) Parents eligible under this subsection may be
enrolled with a different health plan than that selected by
the subscriber. Parents may not add additional dependents to
their insurance coverage.
(7) The enrollee (or the subscriber on their behalf) must
notify the PEBB benefits services program, in writing, no
later than sixty days after the date they are no longer
eligible under this section. A PEBB continuation of coverage
election notice and continued health plan enrollment will only
be available if the PEBB benefits services program is notified
in writing within the sixty-day period.
(Effective January 1, 2009.) WAC 182-12-260
Who are eligible dependents? The
following are eligible as dependents under the PEBB
eligibility rules:
(1) Lawful spouse.
(2) Domestic partner qualified by the PEBB declaration of
domestic partnership that meets all of the following criteria:
(a) Partners have a close personal relationship in lieu
of a lawful marriage;
(b) Partners are not married to anyone;
(c) Partners are each other's sole domestic partner and
are responsible for each other's common welfare;
(d) Partners are not related by blood as close as would
bar marriage; and
(e) Partners are barred from a lawful marriage in
Washington state.
(3) Domestic partner qualified by the certificate of
state registered domestic partnership or registration card
issued by the Washington secretary of state for a same-sex
partnership.
(4) Children. Children are defined as the subscriber's
biological children, stepchildren, legally adopted children,
children for whom the subscriber has assumed a legal
obligation for total or partial support in anticipation of
adoption of the child, children of the subscriber's qualified
domestic partner, or children specified in a court order or
divorce decree. In addition, children include extended
dependents in the legal custody or legal guardianship of the
subscriber, the subscriber's spouse, or subscriber's qualified
domestic partner. The legal responsibility is demonstrated by
a valid court order and the child's official residence with
the custodian or guardian. "Children" does not include foster
children for whom support payments are made to the subscriber
through the state department of social and health services
foster care program.
Eligible children include:
(a) Unmarried children through age nineteen.
(b) Married children through age nineteen who qualify as
dependents of the subscriber under the Internal Revenue Code.
(c) Unmarried children age twenty through age
twenty-three who are attending high school or are registered
students at an accredited secondary school, college,
university, vocational school, or school of nursing
(students). A married child is eligible as a student if the
child is a dependent of the subscriber under the Internal
Revenue Code.
(i) A child is eligible as a student or can maintain
eligibility as a student when not registered for courses
through the summer or off quarter/semester as long as the
child meets all other eligibility requirements and is in any
one of the following circumstances:
• The child attended the three consecutive quarters or
two consecutive semesters before the off quarter/semester.
• The child is an enrolled dependent turning age twenty
or renewing annual student certification and the child is
expected to register for three consecutive quarters or two
consecutive semesters after the off quarter/semester.
• The child recently graduated. Graduation is defined as
the successful completion of studies to earn a degree or
certificate, not the date of the graduation ceremony. The
child is eligible for the three month period following
graduation.
(ii) For student dependents who are not eligible for the
summer or off quarter/semester according to (c)(i) of this
subsection, student eligibility begins the first day of the
month of the quarter or semester for which the child is
registered, and eligibility ends the last day of the month in
which the student stops attending or in which the quarter or
semester ends, whichever is first.
The PEBB benefits services program certifies students
annually. Health plan enrollment ends the last day of the
month in which certification ends or the student ceases to
meet eligibility criteria, whichever comes first. See WAC 182-12-262 (3)(g) and (7) for enrollment requirements.
(d) Unmarried children age twenty through age twenty-four
(adult dependents).
Subscriber must pay the adult dependent premium for adult
dependents whom the subscriber has enrolled. Nonpayment of
premium will result in termination of coverage back to the end
of the month for which the last full month premium was paid.
Adult dependents must enroll in the same health plan as
the subscriber.
Exception:
The adult dependent 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.
(e) Children of any age with disabilities, developmental
disabilities, mental illness or mental retardation who are
incapable of self-support, provided such condition occurs
before age twenty or during the time the dependent was
eligible as a student under (c) of this subsection.
The subscriber must provide evidence that such
disability occurred as stated below:
(i) For a child enrolled in PEBB insurance coverage, the
subscriber must provide evidence of the disability within
sixty days of the child's attainment of age twenty.
(ii) For a child enrolled in PEBB insurance coverage as a
student under (c) of this subsection, the subscriber must
provide evidence of the disability within sixty days after the
student is no longer eligible under (c) of this subsection.
(iii) For a child, age twenty or older, who is a new
dependent or for a child, age twenty or older, who is a
dependent of a newly eligible subscriber, the child may be
enrolled as a dependent child with disabilities if the
subscriber provides evidence that the condition occurred
before the child reached age twenty or evidence that when the
condition occurred the child would have satisfied PEBB
eligibility for student coverage under (c) of this subsection
had the subscriber been eligible for PEBB benefits at the
time.
The subscriber must notify the PEBB benefits services
program, in writing, no later than sixty days after the date
that a child age twenty or older no longer qualifies under
this subsection.
For example, children who become self-supporting are not
eligible under this rule as of the last day of the month in
which they become capable of self-support. The child may be
eligible to continue enrollment as an adult dependent, as per
(d) of this subsection, or in a PEBB health plan under
provisions of WAC 182-12-270.
Children age twenty and older who become capable of
self-support do not regain eligibility under (e) of this
subsection if they later become incapable of self-support.
The PEBB benefits services program will recertify the
eligibility of children with disabilities periodically.
(5) Parents.
(a) Parents covered under PEBB medical before July 1,
1990, may continue enrollment on a self-pay basis as long as:
(i) The parent maintains continuous enrollment in PEBB
medical;
(ii) The parent qualifies under the Internal Revenue Code
as a dependent of the subscriber;
(iii) The subscriber continues enrollment in PEBB
insurance coverage; and
(iv) The parent is not covered by any other group medical
plan.
(b) Parents eligible under this subsection may be
enrolled with a different health plan than that selected by
the subscriber. Parents may not add additional dependents to
their insurance coverage.
(6) The enrollee (or the subscriber on their behalf) must
notify the PEBB benefits services program, in writing, no
later than sixty days after the date they are no longer
eligible under this section. A PEBB continuation of coverage
election notice and continued health plan enrollment will only
be available if the PEBB benefits services program is notified
in writing within the sixty-day period.