TABLE OF CONTENTS Benefit Summary .............................................................................................................. 1 Introduction ...................................................................................................................... 7 Definitions ......................................................................................................................... 8 Medical Plan Eligibility and Enrollment ....................................................................... 15 Eligibility for Subscribers and Dependents ............................................................................................................ 15 Employee Eligibility ............................................................................................................................................ 15 Continuation Coverage Eligibility ..................................................................................................................... 15 Dependent Eligibility .......................................................................................................................................... 15 Enrollment for Subscribers and Dependents ........................................................................................................ 16 For All Subscribers and Dependents ................................................................................................................ 16 Employee Enrollment ......................................................................................................................................... 17 Continuation Coverage Enrollment ................................................................................................................. 17 Dependent Enrollment ....................................................................................................................................... 18 Dual Enrollment .................................................................................................................................................. 19 Medicare Eligibility and Enrollment ........................................................................................................................ 19 Employee and Dependent ................................................................................................................................. 19 Continuation Coverage Subscriber, a retired employee of a former employer group, or their Dependent ............................................................................................................................................................ 19 When Medical Coverage Begins ............................................................................................................................... 20 Employees and Dependents .............................................................................................................................. 20 Continuation Coverage Subscribers and Dependents ................................................................................... 20 All Subscribers and Dependents ....................................................................................................................... 20 Making changes .......................................................................................................................................................... 21 Removing a Dependent Who is No Longer Eligible ..................................................................................... 21 Voluntary Termination for Continuation Coverage Subscribers or retired employees of a former employer group .................................................................................................................................................... 21 Making Changes during Annual Open Enrollment and Special Open Enrollment .................................. 21 When Medical Coverage Ends ................................................................................................................................. 26 Termination Dates............................................................................................................................................... 26 Final Premium Payments ................................................................................................................................... 27 Options for Continuing PEBB Medical Coverage ......................................................................................... 28 Family and Medical Leave Act of 1993 ............................................................................................................ 28 Paid Family and Medical Leave Act .................................................................................................................. 29 Conversion of Coverage ..................................................................................................................................... 29 General provisions for eligibility and enrollment .................................................................................................. 29 Payment of Premiums During a Labor Dispute ............................................................................................. 29 Termination for Just Cause ................................................................................................................................ 29 Appeal Rights ....................................................................................................................................................... 30 Relationship to Law and Regulations ............................................................................................................... 30 How to Obtain Services ................................................................................................. 30 EWCLGHDHP1983ACT0124 WAPEBB-CD-ACT