Eligibility

Unsubsidized Dependents Covered under a PEBP Plan

• An unsubsidized dependent is an otherwise eligible spouse/domestic partner or dependent child who remains covered under PEBP while the primary Plan participant transitions medical coverage to the Medicare Exchange.
• Termination of a primary participant’s coverage will result in termination of the unsubsidized dependents.
• Unsubsidized dependents enrolled in the CDHP, LD, EPO or HMO plan can decline their coverage at any time (coverage ends the last day of the month of notification).

Unsubsidized Dependents Covered under the Medicare Exchange

• An unsubsidized dependent is an otherwise eligible spouse/domestic partner who transitions to the Medicare Exchange and elects PEBP dental coverage, while the primary Plan participant remains covered under a PEBP Plan.
• Termination of a primary participant’s coverage will result in termination of the unsubsidized dependent.
• Unsubsidized dependents enrolled in the Medicare Exchange with PEBP dental coverage can decline their coverage at any time (coverage ends the last day of the month of notification).

Employees with an initial hire date on or after January 1, 2012 may enroll in retiree coverage but will not qualify for a retiree premium subsidy or Exchange HRA contribution.

EPO and HMO participants who move outside of their designated plan’s coverage area must select a new medical plan to coincide with their new coverage area within 30 days. Contact PEBP Members Services to notify them and discuss your options.

A spouse or domestic partner who is eligible for other employer group coverage is not eligible for coverage as a dependent under this plan. Exceptions may apply if the employer group coverage is determined to be significantly inferior. “Significantly inferior” refers to a plan that offers limited benefits, such as a mini-med plan or a catastrophic plan with a $5,000 or greater individual deductible and the plan is not coupled with an HSA or HRA.

No. A dependent cannot be covered under two PEBP plans at the same time.

Newborn dependent child(ren) will automatically be covered under PEBP from the date of birth to 31 days following the date of birth. To continue coverage beyond the initial coverage period, enrollment must be completed within 60 days of the newborn’s date of birth.

A dependent child under the age of 26 years who is covered as a dependent on his or her parent’s PEBP Plan, and who later becomes eligible for their own PEBP coverage as a primary PEBP participant, may decline primary coverage as an active employee and retain coverage as a dependent on his or her parent’s plan; or the newly eligible employee (dependent) may enroll in their own coverage as a primary PEBP participant.

Employees hired on the first day of the month are eligible for benefits on their date of hire. Employees hired on the second day through the last day of the month are eligible for benefits on the first day of the month following their date of hire. For example, if you were hired on June 1, your benefit eligibility would begin that day. If you were hired on June 2, your benefit eligibility would begin July 1.

You will not have to wait until open enrollment to add your spouse/domestic partner. The loss of employer-sponsored group coverage is a qualified family status event. However, you must complete the dependent loses coverage event in your E-PEBP portal within 60-days of the date your spouse/domestic partner’s other coverage ended. This event requires a certificate of credible coverage letter with the dependent’s full name and date of termination of coverage, and a copy of your certified marriage certificate or certificate of domestic partnership to complete the event.

The covered dependents of a deceased active employee who had 10 or more years of service credit may continue coverage by re-joining the program as a survivor within 60 days of the employee’s death. Survivor dependent(s) of retirees who were covered on the date of the retiree’s death have the option either to continue or cancel PEBP coverage.