o 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. o 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. o The PEBB Program, with input from the medical plan 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. 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 medical coverage will be enrolled in the same medical Plan as the Subscriber. Exceptions apply for non-Medicare enrollees when a subscriber selects a Medicare Supplement, Medicare Advantage, or Medicare Advantage Prescription Drug plan. Employee Enrollment An employee must reside or work in the Plan’s Service Area. An employee’s dependent must also reside in the plan’s service area, except for temporary residency outside the Service Area for purposes of attending school, court-ordered coverage for Dependents or other unique family arrangements, when approved in advance by KFHPNW. KFHPNW has the right to verify eligibility. An employee must use Benefits 24/7, the online enrollment system (once available), or submit a PEBB Employee Enrollment/Change or PEBB Employee Enrollment/Change (for Medical Only Groups) form and any supporting documents to their Employing Agency when they become newly eligible or regain eligibility for PEBB benefits. The online enrollment must be completed or the form must be received no later than 31 days after the date the employee becomes eligible or regains eligibility. If the employee does not enroll online or return the form by the deadline, the employee will be enrolled in Uniform Medical Plan Classic and a tobacco use premium surcharge will be incurred. Consequently, 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 for enrolling a Dependent. Waiving Medical Enrollment An eligible employee may waive enrollment in PEBB medical if they are enrolled in other employer-based group medical, a TRICARE plan, or Medicare. They may not waive enrollment in PEBB medical if they are enrolled in PEBB retiree insurance coverage. When a retiree becomes eligible for the employer contribution toward PEBB benefits, PEBB retiree insurance coverage will be automatically deferred. If an employee waives enrollment in PEBB medical, the employee cannot enroll eligible Dependents. For information on when an eligible employee may waive medical plan enrollment after their initial enrollment period, or to enroll after having waived, see “Making Changes.” Continuation Coverage Enrollment A Subscriber enrolling in PEBB Continuation Coverage (COBRA or Unpaid Leave) may enroll by using Benefits 24/7, the online enrollment system (once available), or by submitting the applicable PEBB Continuation Coverage Election/Change form and any supporting documents to the PEBB Program. The online enrollment must be completed or 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. EWCLGDED1983ACT0124 16 WAPEBB-CL-ACT