Wash. Admin. Code § 182-16-2030 – Appealing a public employees benefits board (PEBB) program decision regarding eligibility, enrollment, premium payments, premium surcharges, a PEBB wellness incentive, or certain decisions made by an employer group

(1) A decision made by the public employees benefits board (PEBB) program regarding eligibility, enrollment, premium payments, premium surcharges, or a PEBB wellness incentive, may be appealed by submitting a request to the PEBB appeals unit for a brief adjudicative proceeding to be conducted by the authority.
(2) A decision made by a PEBB participating employer group regarding life insurance, LTD insurance, eligibility to participate in the PEBB wellness incentive program, or eligibility to receive a PEBB wellness incentive, may be appealed by submitting a request to the PEBB appeals unit for a brief adjudicative proceeding to be conducted by the authority.
(3) The contents of the request for a brief adjudicative proceeding are to be provided as described in WAC 182-16-2070.
(4) The request for a brief adjudicative proceeding from a current or former employee or employee's dependent must be received by the PEBB appeals unit no later than 30 days after the date of the denial notice.
(5) The request for a brief adjudicative proceeding from a retiree, a continuation coverage enrollee, a retired employee or retired school employee continuing PEBB health plan coverage when their employer group ceases participation, a survivor, or their dependent must be received by the PEBB appeals unit no later than 60 days after the date of the denial notice.
(6) The PEBB appeals unit must notify the appellant in writing when the request for a brief adjudicative proceeding has been received.
(7) The brief adjudicative proceeding will be conducted by a presiding officer designated by the director.
(8) Failing to timely request a brief adjudicative proceeding will result in the prior PEBB program decision becoming the authority's final order without further action.

[Statutory Authority: RCW 41.05.021, 41.06.065 [ 41.05.065], and 41.05.160. WSR 24-18-076 (Admin #2024-01.01), § 182-16-2030, filed 8/29/24, effective 1/1/25. Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 20-16-062 (Admin #2020-03), § 182-16-2030, filed 7/28/20, effective 1/1/21. Statutory Authority: RCW 41.05.021, 41.05.160, and PEBB policy resolutions. WSR 19-17-073 (Admin #2019-01), § 182-16-2030, filed 8/20/19, effective 1/1/20. Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 18-22-033 (Admin #2018-03), § 182-16-2030, filed 10/29/18, effective 1/1/19.]