HTML has links - PDF has Authentication
182-30-080  <<  182-30-085 >>   182-30-090

PDFWAC 182-30-085

What happens if my health plan becomes unavailable due to a change in contracted service area or eligibility for medicare?

(1) A subscriber must select a new health plan when their previously selected health plan becomes unavailable due to a change in contracting service area as described below:
(a) When a health plan becomes unavailable during the plan year, a subscriber must elect a new health plan no later than sixty days after the date their previously selected health plan becomes unavailable.
(i) A school employee must submit the required form to their school employees benefits board (SEBB) organization electing their new health plan.
(ii) All other subscribers must submit the required forms to the SEBB program electing their new health plan.
(iii) The effective date of the change in health plan will be the first day of the month following the later of the date the health plan becomes unavailable or the date the form is received. If that day is the first of the month, the change in health plans begins on that day.
(b) When a health plan becomes unavailable at the beginning of the next plan year, a subscriber must elect a new health plan no later than the last day of the SEBB annual open enrollment.
(i) A school employee must submit the required forms to their SEBB organization electing their new health plan.
(ii) Any other subscriber must submit the required forms to the SEBB program electing their new health plan.
(iii) The effective date of the change in health plan will be January 1st of the following year.
(c) A subscriber who fails to elect a new health plan within the required time period as required in (a) or (b) of this subsection will be enrolled in a health plan designated by the director or their designee.
(2) A subscriber must elect a new health plan when their previously selected health plan becomes unavailable due to the subscriber or subscriber's dependent ceasing to be eligible for their current health plan because of enrollment in medicare as described below:
(a) The required forms electing a new health plan must be received no later than sixty days after the date their previously selected health plan becomes unavailable.
(b) A school employee must submit the required forms to their SEBB organization electing their new health plan.
(c) All other subscribers must submit the required forms to the SEBB program electing their new health plan.
(d) The effective date of the change in their health plan will be the first day of the month following the later of the date the health plan becomes unavailable or the date the form is received. If that day is the first of the month, the change in the health plan begins on that day.
(e) A subscriber who is enrolled in a high deductible health plan (HDHP) with a health savings account (HSA), will not be eligible to receive contributions to the HSA, and will be liable for any tax penalties resulting from contributions made when they are no longer eligible.
(3) A subscriber enrolled in a health plan as described in subsection (1)(c) or (2)(e) of this section may not change health plans except as allowed in WAC 182-30-090.
[Statutory Authority: RCW 41.05.021, 41.05.160 and 2020 c 231. WSR 20-16-067 (Admin #2020-04), § 182-30-085, filed 7/28/20, effective 8/28/20. Statutory Authority: RCW 41.05.021, 41.05.160, 2017 3rd sp.s. c 13, 2018 c 260, and SEBB policy resolutions. WSR 19-14-093 (Admin #2019-01), § 182-30-085, filed 7/1/19, effective 8/1/19.]
Site Contents
Selected content listed in alphabetical order under each group