Changing Medical/Dental Enrollment
for Faculty, Staff & Librarians
Special Open Enrollment - Loss of Eligibility
When subscriber loses an eligible dependent or dependent loses eligibility due to:
- Child dependent turns age 26.
- Child dependent ceases to be eligible as an extended dependent.
- Child dependent ceases to be eligible as a dependent with disabilities.
| Options |
Required Actions |
| If you are the subscriber and you are already enrolled: |
You must:
- Remove your ineligible dependent from your PEBB health insurance plans. Failure to do so may have the following consequences:
- Dependent's loss of eligibility to continue enrollment under one of the continuation options (i.e. COBRA)
- You may be billed for claims paid by the health plan for services after the dependent lost eligibility
- You will be responsible for all premiums (employee/employer) for the dependent's health plan enrollment after the dependent lost eligibility.
You may:
- Change your medical and/or dental plan coverage.
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Within 60 days of a qualifying life event listed above, submit this form to the Benefits Office:
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| Coverage Begins |
- Coverage or Plan Change: Begins the first day of the month following the dependent's loss of eligibility from the plan.
- Ineligible Dependent(s) : Enrollment ends the last day of the month in which they are no longer eligible to be on the plan.
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| Important Reminders |
- Evaluate your life insurance coverage and retirement plan to make sure your beneficiary designations are current. See Beneficiary Designations.
- You may enroll, change, or cancel your participation in these optional tax-savings programs.
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| Resources |
COBRA - Continuing Insurance
Flexible Spending Account
Dependent Care Assistance Program
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Disclaimer: The Qualifying Life Event(s) shown above highlights benefit options arising from a change in family status. It does not substitute for official plan documents. If there is a conflict between the information on this site and an official plan document, the official plan document will govern. Plan availability and eligibility may change depending on your employment status and/or actions of the Washington State Health Care Authority.
