Premiums and applicable premium surcharges associated with continuing PEBB medical must be made directly to HCA. The first premium payment and applicable premium surcharges are due to HCA no later than 45 days after the election period ends as described above. Note: Enrollment in the Kaiser Permanente WA Medicare Advantage (MA) plan may not be retroactive. If a subscriber is eligible for and elects this plan and the online enrollment or the required forms are received by the PEBB Program after the date PEBB health plan coverage is to begin, the subscriber and their enrolled dependents will be enrolled in another Kaiser Permanente WA plan during the gap month(s) prior to when the Kaiser Permanente WA MA plan begins. 6. Dependent enrollment To enroll an eligible dependent, the employee must include the dependent’s information online using Benefits 24/7 (once available) or on the applicable enrollment form and provide the required document(s) as proof of the dependent’s eligibility. The dependent will not be enrolled in PEBB health plan coverage if the PEBB Program or the employing agency is unable to verify their eligibility within the PEBB Program enrollment timelines. 7. National Medical Support Notice (NMSN). When a National Medical Support Notice (NMSN) requires a subscriber to provide health plan coverage for a dependent child the following provisions apply: The subscriber may enroll their dependent child and request changes to their health plan coverage as described under “Changes to health plan coverage or enrollment are allows as directed by the NMSN,” below. • An employee must use Benefits 24/7 (once available) or submit the required form(s) to their employing agency. • Any other subscriber must use Benefits 24/7 (once available) or submit the required form(s) to the PEBB Program. If the subscriber fails to request enrollment or health plan coverage changes as directed by the NMSN, the employing agency or the PEBB Program may make enrollment or health plan coverage changes according to “Changes to health plan coverage or enrollment are allowed as directed by the NMSN,” below, upon request of: • The child’s other parent; or • Child support enforcement program. Changes to health plan coverage or enrollment are allowed as directed by the NMSN: a. The dependent will be enrolled under the subscriber’s health plan coverage as directed by the NMSN; b. An employee who has waived PEBB medical will be enrolled in medical as directed by the NMSN, in order to enroll the dependent; c. The subscriber’s selected health plan will be changed if directed by the NMSN; d. If the dependent is already enrolled under another PEBB subscriber, the dependent will be removed from the other health plan coverage and enrolled as directed by the NMSN; e. If the dependent is enrolled in both PEBB medical and School Employee Benefits Board (SEBB) medical as a dependent and there is NMSN in place, enrollment will be in accordance with the NMSN; or f. If the subscriber is eligible for and elects Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage or other continuation coverage, the NMSN will be enforced and the dependent must be covered in accordance with the NMSN. PEBB_CA_2024 50