Purchasing health services and items through these merchants can lower the number of additional substantiation requests. Remember to keep your receipts in case additional proof is requested. Participating merchants generally include: • Provider offices • Dental and vision clinics • IIAS participating merchants You can find a list of IIAS participating merchants at pebb.naviabenefits.com. How do I receive information from Navia Benefit Solutions? You can choose your method of communication. For example, if you provide an email address, statements and other communications will be sent automatically to your email. You may change your method of communication or opt out of email delivery either online or by contacting Navia Benefit Solutions directly at any time. When can I make changes? You cannot change your election amount or cancel participation in the Limited Purpose FSA once the plan year starts unless you end employment, lose eligibility for the Limited Purpose FSA, or experience an event that creates a special open enrollment (SOE). Some of these events are listed below. • Employee gains a new dependent due to: o Marriage; o Registering a domestic partnership, if the state-registered domestic partner qualifies as a tax dependent; o Birth, adoption, or when the subscriber has assumed a legal obligation for support ahead of adoption; or o A child becoming eligible as an extended dependent through legal custody or legal guardianship; • Employee's dependent no longer meets PEBB eligibility criteria due to: o Employee’s change in marital status; o Employee's domestic partnership with a state registered domestic partner, who is a tax dependent, is dissolved or terminated; o A dependent losing eligibility as an extended dependent or as a dependent with a disability; o A dependent child turning age 26; or otherwise no longer meeting dependent child eligibility; or o A dependent dies. • Employee or the employee’s dependent loses other coverage under a group health plan or through health insurance coverage, as defined by the Health Insurance Portability and Accountability Act (HIPAA). • Employee or a dependent has a change in employment status that affects eligibility for the Limited Purpose FSA. • A court order requires the employee or any other person to provide insurance coverage for an eligible dependent of the employee. • Employee or an employee’s dependent enrolls in or loses eligibility for coverage under Medicaid or a state Children's Health Insurance Program (CHIP). • Employee or an employee’s dependent enrolls in or loses eligibility for coverage under Medicare. If you experience a qualifying event as described above, and need to enroll, change your election amount, or cancel your enrollment in your Limited Purpose FSA, download the PEBB Change in Status Form from pebb.naviabenefits.com. (Exception: UW and WSU employees must submit the change in status through Workday.) 8
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