TABLE OF CONTENTS Benefit Summary ..............................................................................................................1 Introduction ......................................................................................................................7 Definitions .........................................................................................................................7 Medical Plan Eligibility and Enrollment ...................................................................... 14 Eligibility for Subscribers and Dependents ........................................................................................................... 14 Employee Eligibility ........................................................................................................................................... 14 Continuation Coverage Eligibility .................................................................................................................... 14 Dependent Eligibility ......................................................................................................................................... 15 Enrollment for Subscribers and Dependents ....................................................................................................... 16 For All Subscribers and Dependents ............................................................................................................... 16 Employee Enrollment ........................................................................................................................................ 16 Continuation Coverage Enrollment ................................................................................................................ 16 Dependent Enrollment ...................................................................................................................................... 17 Dual Enrollment ................................................................................................................................................. 18 Medicare Eligibility and Enrollment ....................................................................................................................... 18 Employee and Dependent ................................................................................................................................ 18 Continuation Coverage Subscriber, a retired employee of a former employer group, or their Dependent ........................................................................................................................................................... 19 When Medical Coverage Begins .............................................................................................................................. 19 Employees and Dependents ............................................................................................................................. 19 Continuation Coverage Subscribers and Dependents .................................................................................. 19 All Subscribers and Dependents ...................................................................................................................... 20 Making changes ......................................................................................................................................................... 20 Removing a Dependent Who is No Longer Eligible .................................................................................... 20 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 .................................................................................................................................. 26 Options for Continuing PEBB Medical Coverage ........................................................................................ 27 Family and Medical Leave Act of 1993 ........................................................................................................... 28 Paid Family and Medical Leave Act ................................................................................................................. 28 Conversion of Coverage .................................................................................................................................... 28 General provisions for eligibility and enrollment ................................................................................................. 29 Payment of Premiums During a Labor Dispute ............................................................................................ 29 Termination for Just Cause ............................................................................................................................... 29 Appeal Rights ...................................................................................................................................................... 29 Relationship to Law and Regulations .............................................................................................................. 29 How to Obtain Services ................................................................................................ 30 EWCLGDED1983ACT0124 WAPEBB-CL-ACT