custodian or guardian. Extended dependent child does not include foster children unless the subscriber, the subscriber’s spouse, or the subscriber’s state-registered domestic partner has assumed a legal obligation for total or partial support in anticipation of adoption. o Children of any age with a developmental or physical disability that renders them incapable of self-sustaining employment and chiefly dependent upon the subscriber for support and maintenance, provided such condition occurs before the age of 26. The following requirements apply to a dependent child with a disability: ▪ The subscriber must provide proof of the disability and dependency within 60 days of the child’s attainment of age 26. ▪ The subscriber must notify the PEBB Program in writing when the child is no longer eligible under this subsection. ▪ A child with a developmental or physical disability who becomes self-supporting is not eligible as of the last day of the month in which they become capable of self-support. ▪ A child with a developmental or physical disability age 26 and older who becomes capable of self-support does not regain eligibility if they later become incapable of self-support. ▪ The PEBB Program (with input from the medical plan, if enrolled in medical) will periodically verify the eligibility of a dependent child with a disability beginning at age 26, but no more frequently than annually after the two-year period following the child’s 26th birthday. Verification will require renewed proof of disability and dependence from the subscriber. A retiree, a survivor, or their enrolled dependents are required to enroll and stay enrolled in Medicare Part A and Part B, if eligible. This is a condition of their enrollment in a PEBB retiree health plan. A retiree or survivor must provide a copy of their or their dependent’s Medicare card or entitlement letter from the Social Security Administration with Medicare Part A and Part B effective dates to the PEBB Program as proof of enrollment in Medicare. If a retiree, a survivor, or their dependent is not enrolled in either Medicare Part A or Part B on their 65th birthday, the retiree or survivor must provide the PEBB Program with a copy of the denial letter from the Social Security Administration. The only exception to this rule is for an employee or school employee who retired on or before July 1, 1991. Enrollment for subscribers and dependents For all subscribers and dependents • To enroll at any time other than during the initial enrollment period, see “Making changes.” • Any dependents enrolled in dental coverage will be enrolled in the same dental plan as the subscriber. Employee enrollment An employee is required to enroll in a dental plan unless otherwise described in PEBB Program rules. An employee must submit a PEBB Employee Enrollment/Change form and any supporting documents to their employing agency when they become newly eligible or regain eligibility for PEBB benefits. The forms must be received by their employing agency no later than 31 days after the date the employee becomes eligible or regains eligibility. If the employee does not return the form by the deadline, the employee will be enrolled in Uniform Dental Plan. Dependents cannot be enrolled until the PEBB Program’s next annual open enrollment or when a qualifying event occurs that creates a special open enrollment that allows enrolling a dependent. See “Special open enrollment.” Continuation coverage enrollment A continuation coverage subscriber or their dependent can enroll in only one PEBB dental plan, even if eligibility criteria is met under two or more subscribers. A subscriber enrolling in PEBB Continuation Coverage (COBRA or Unpaid Leave) may enroll by submitting the applicable PEBB Continuation Coverage Election/Change form and any supporting documents to the PEBB Program. The PEBB Program must receive the election form no later than 60 days from the date the enrollee’s PEBB health plan coverage ended or from the postmark date on the PEBB Continuation Coverage Election Notice sent by the PEBB Program, whichever is later. Premiums and applicable premium surcharges associated with continuing PEBB dental must be made directly to HCA. The first premium payment and applicable premium surcharges are due to HCA no later than 45 days after 2024-01-03000-BB 20 LG PPOL 20240101