8 2024 Evidence of Coverage for WA PEBB Kaiser Permanente Senior Advantage Chapter 1: Getting started as a member Your group can tell you the term of this Evidence of Coverage and whether this Evidence of Coverage is still in effect, and give you a current one if this Evidence of Coverage has been amended. Medicare (the Centers for Medicare & Medicaid Services) must approve our plan each year. You can continue each year to get Medicare coverage as a member of our plan only as long as your group continues to offer this plan, we choose to continue to offer our plan, and Medicare renews its approval of our plan. Section 2 — What makes you eligible to be a plan member? Section 2.1 – Your Senior Advantage eligibility requirements You are eligible for membership in our plan as long as: • You have both Medicare Part A and Medicare Part B. • You live in our geographic service area (Section 2.3 below describes our service area). If you have been a member of our plan continuously since before January 1999 and you were living outside of our service area before January 1999, you are still eligible as long as you have not moved since before January 1999. Incarcerated individuals are not considered living in the geographic service area even if they are physically located in it. • You are a United States citizen or are lawfully present in the United States. • You have been determined to be eligible and are enrolled in PEBB retiree insurance coverage. Refer to Section 2.2 for group eligibility requirements. Note: If you are enrolled in a Medicare plan and lose Medicare eligibility, you may be able to enroll under your group's non-Medicare plan if that is permitted by your group (please ask your group for details). Section 2.2 – Eligibility and enrollment for a retiree or survivor In these sections, the term "retiree" or "retiring employee" includes a retiring employee from a Public Employees Benefits Board (PEBB) employing agency or employer group and an elected or full-time appointed official of the legislative and executive branch of state government eligible to continue enrollment in PEBB retiree insurance coverage. The term "retiree" or "retiring school employee" includes a retiring school employee from a School Employees Benefits Board (SEBB) organization or employer group. Additionally, "health plan" is used to refer to a plan offering medical or dental, or both, developed by PEBB and provided by a contracted vendor or self-insured plans administered by the Health Care Authority (HCA). Eligibility for subscribers and dependents Retiree eligibility The PEBB Program determines if a retiring employee or retiring school employee is eligible to enroll in PEBB retiree insurance coverage upon receipt of their election to enroll. If the retiring employee or retiring school employee does not have substantive eligibility or does not meet the procedural requirements for enrollment in PEBB retiree insurance coverage, the PEBB Program kp.org