State Agency: An office, department, board, commission, institution, or other separate unit or division, however designated, of the Washington state government. It includes the legislature, executive branch, and agencies or courts within the judicial branch, as well as institutions of higher education and any unit of state government established by law. State-Registered Domestic Partner. An adult who meets the requirements for a valid state-registered domestic partnership and has been issued a certificate of state-registered domestic partnership by the Washington State Secretary of State, or an adult whose legal union (other than a marriage) is validly formed in another jurisdiction and is substantially equivalent to a domestic partnership under Washington law. Subscriber. The retiree, Continuation Coverage Enrollee, or survivor who has been determined eligible and is enrolled in this plan, and is the individual to whom the PEBB Program or Kaiser will issue notices, information, requests, and premium bills on behalf of an Enrollee. Substance Use Disorder. A substance-related or addictive disorder listed in the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. Urgent Care. Treatment for an unforeseen condition that requires prompt medical attention to keep it from becoming more serious, but that is not an Emergency Medical Condition. Utilization Review. The formal application of criteria and techniques designed to ensure that each Member is receiving Services at the appropriate level; used as a technique to monitor the use of or evaluate the medical necessity, appropriateness, effectiveness, or efficiency of a specific Service, procedure, or setting. Year. A period of time that is a calendar year beginning on January 1 of any year and ending at midnight December 31 of the same year. MEDICAL PLAN ELIGIBILITY AND ENROLLMENT In these sections, “health plan” is used to refer to a plan offering medical or dental, or both, developed by the Public Employees Benefits Board (PEBB) and provided by a contracted vendor or self-insured plans administered by the Health Care Authority (HCA). Eligibility for Subscribers and Dependents Employee Eligibility The employee’s State Agency will inform the employee in writing whether or not they are eligible for PEBB benefits upon employment and whenever their eligibility status changes. The written notice will include information about the employee’s right to appeal eligibility and enrollment decisions. An employee of an employer group (such as a county, city, port, water district, etc.) that contracts with HCA for PEBB benefits should contact their payroll or benefits office for eligibility criteria. Employees have the right to appeal eligibility and enrollment decisions. Information about appeals can be found under “Appeal Rights.” Continuation Coverage Eligibility The PEBB Program determines whether Subscribers are eligible for Continuation Coverage (COBRA or Unpaid Leave) upon receipt of their election to enroll in PEBB Continuation Coverage (COBRA or Unpaid Leave). If the Subscriber requests to enroll in and is not eligible for Continuation Coverage, the PEBB Program will notify them of their right to appeal. Information about appeals can be found under “Appeal Rights.” EWCLGDED1983ACT0124 14 WAPEBB-CL-ACT