2024 Evidence of Coverage for WA PEBB Kaiser Permanente Senior Advantage 11 Chapter 1: Getting started as a member or the dependent of an employee, or such medical insurance continued under Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage or continuation coverage. • Beginning January 1, 2001, enrollment in PEBB retiree insurance coverage may be deferred when the subscriber is enrolled as a retiree or the dependent of a retiree in a federal retiree medical plan. • Beginning January 1, 2006, enrollment in PEBB retiree insurance coverage may be deferred when the subscriber is enrolled in Medicare Parts A and B and a Medicaid program that provides creditable coverage. Eligible dependents who are not enrolled in Medicaid coverage that provides creditable coverage may be enrolled. • Beginning January 1, 2014, subscribers who are not eligible for Medicare Part A and Part B may defer enrollment in PEBB retiree insurance coverage when the subscriber is enrolled in qualified health plan coverage through a health benefit exchange developed under the Affordable Care Act. • Beginning July 17, 2018, enrollment in PEBB retiree insurance coverage may be deferred when the subscriber is enrolled in the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). Exception: A retiree may defer enrollment in PEBB retiree insurance coverage during the period of time they are enrolled as a dependent in a medical plan sponsored by PEBB or School Employees Benefits Board (SEBB), including such coverage under COBRA or continuation coverage. They do not need to elect to defer enrollment online or submit a PEBB Retiree Election Form. If a retiree or a survivor chooses to defer enrollment in PEBB medical, enrollment in PEBB dental will also be deferred. Enrollment in PEBB retiree insurance coverage is automatically deferred if a retiree or a survivor becomes eligible for the employer contribution toward PEBB benefits. They do not need to elect to defer enrollment online or submit a PEBB Retiree Election Form. If a retiree or a survivor becomes eligible for the employer contribution toward SEBB benefits and enrolls in a SEBB health plan, they may request to defer enrollment in PEBB retiree insurance coverage. A retiree or a survivor who deferred their enrollment in PEBB retiree insurance coverage may enroll as described in "Enrollment following deferral" later in this section. Retiree and survivor enrollment An eligible retiree, a survivor, or their dependent can enroll in only one PEBB medical plan, even if eligibility criteria is met under two or more subscribers. An eligible retiring employee or a retiring school employee must enroll using Benefits 24/7, the online enrollment system (once available), or submit a PEBB Retiree Election Form (form A) along with any other required forms and supporting documents to the PEBB Program. The online enrollment must be completed or the forms must be received no later than 60 days after the employee's or the school employee's own employer-paid coverage, COBRA coverage, or continuation coverage ends. The first premium payment and applicable premium surcharges are due to HCA no later than 45 days after the election period ends. 1-877-221-8221 (TTY 711), 7 days a week, 8 a.m. to 8 p.m.