14. Over-the-counter items such as hearing aids unless specifically listed as covered in Section IV. 15. Academic/career counseling, counseling for overeating, work/school ordered assessments, relationship counseling, custodial care 16. Court-ordered or forensic treatment, including reports and summaries, not considered Medically Necessary. VI. Eligibility, Enrollment and Termination 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). A. Eligibility. 1. Eligible Employees. 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”. 2. 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”. 3. Retired employee of a former employer group eligibility The PEBB Program determines whether a retired employee or a retired school employee of a former employer group is eligible to self-pay coverage upon receipt of their election to enroll. If the retired employee or the retired school employee requests to enroll and is not eligible, the PEBB Program will notify them of their right to appeal. Information about appeals can be found under “Appeal rights.” 4. Eligible Dependents. The following are eligible as dependents: 1. Legal spouse. 2. State-registered domestic partner and substantially equivalent legal unions from jurisdictions as defined in Washington State statute. Individuals in a state-registered domestic partnership are treated the same as a legal spouse except when in conflict with federal law. 3. Children. Children are eligible through the last day of the month in which their 26th birthday occurred regardless of marital status, student status, or eligibility for coverage under another plan. It also includes children age 26 or older with a disability as described below in “Children of any age with a developmental or physical disability.”. Children are defined as the subscriber’s: a. Children based on establishment of a parent-child relationship, as described in Washington State statutes, except when parental rights have been terminated; b. Children of the subscriber’s spouse, based on the spouse’s establishment of a parent-child relationship, except when parental rights have been terminated. The stepchild’s relationship to the PEBB_VA_2024 48