(Exception: University of Washington [UW] and Washington State University [WSU] employees must enroll through Workday.) You are enrolling during the PEBB Program’s annual open enrollment. 2. Enroll no later than the last day of the PEBB Program annual open enrollment. • You can enroll online through Navia’s portal at pebb.naviabenefits.com. (Exception: UW and WSU employees must enroll through Workday.) Online enrollment through Navia’s portal is only available during the PEBB Program annual open enrollment. • Instead of enrolling online, you can download and print the PEBB Open Enrollment Form at pebb.naviabenefits.com. (This option is not available to UW or WSU employees.) Navia must receive your enrollment form by November 30, 2023. Forms received after that date will not be accepted for 2024 Limited Purpose FSA enrollment. • You must enroll in a Limited Purpose FSA again for each year you want to participate. Enrollment does not automatically continue from plan year to plan year. You are enrolling after a life event which qualifies for a Special Open Enrollment. 3. Enroll no later than 60 days after you or an eligible dependent experience a qualifying life event, like a birth or marriage, that creates a special open enrollment. See “When can I make changes?” for details on special open enrollment events. • If you have a qualifying event, submit the PEBB Change of Status Form with evidence of the event, to your payroll or benefits office within the required timeframe. (Exception: UW and WSU employees must use Workday.) • You can find the form online at pebb.naviabenefits.com, or request it from your employer. When does my coverage begin? • If you enroll when you first become eligible for PEBB benefits, your coverage begins the first day of the month after the date you become a PEBB benefits-eligible employee and your payroll or benefits office receives your PEBB Midyear Enrollment Form (or enrollment in Workday, for UW and WSU employees) within the required timeframe. If that date is the first working day of a month, your Limited Purpose FSA enrollment will begin on that day. • If you enroll during the PEBB Program annual open enrollment, your Limited Purpose FSA is effective the following January 1 through December 31. • If you have a qualifying event that creates a special open enrollment allowing an enrollment or election change, it will be effective the first day of the month after the later of: o The event date. o The date your payroll or benefits office receives the PEBB Change of Status Form and evidence of the event. Exception: If the special open enrollment is due to the birth or adoption (or legal obligation for support ahead of adoption), the enrollment or change will begin the first of the month in which the event occurs. Whose expenses qualify? The Limited Purpose FSA covers dental and vision expenses that occur during the plan year for you, your spouse or state-registered domestic partner (SRDP), or your qualified dependents, even if they are not enrolled in your PEBB medical or dental plan. You may also claim certain expenses for a child for whom you don’t get the tax exemption due to a divorce decree, as long as one parent claims the child as a dependent. The exemption may switch from year to year between parents. If one parent receives the tax exemption, the dental or vision expenses you pay on behalf of the child may qualify for the Limited Purpose FSA reimbursement. What expenses are eligible? Only dental and vision expenses are eligible for reimbursement through a Limited Purpose FSA. For a complete list of eligible expenses, visit pebb.naviabenefits.com/benefits/expenses or call Navia Benefit Solutions at 1-800-669-3539. 4