PEBTF - New Rules for Making Changes
New Rules for Making Changes to PEBTF Health Benefits
Changes must be made within 60 days of a qualifying life event
Effective February 1, PEBTF-covered employees may only enroll, add dependents, remove dependents, or disenroll from a health plan as a result of a qualifying life event. Common qualifying life events include:
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marriage, divorce, birth or adoption
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moving to an area of the state not covered by your current plan
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the loss of a dependent’s health coverage provided by another source
You must submit a signed PEBTF-2 form to your agency’s HR office within 60 days of the qualifying life event. If you don’t, you’ll have to wait to make the change during the next open enrollment period. Your local HR office can supply you with the form.
As a reminder, you are required to remove dependents when they are no longer eligible for PEBTF coverage. For example, in the case of divorce, you must remove your former spouse from PEBTF benefits effective the date of divorce. Claims incurred after the date of divorce are your responsibility.
Another change is being made: in accordance with the Internal Revenue Code, retroactive changes that impact employee deductions will be taken as post-tax deductions.
For more information please review the attached fact sheet or contact the PEBTF at
1-800-522-7279.
New Enrollment Rules:
Attention PEBTF Eligible Employees:
Important Information for Making Health Benefit Changes
Throughout your employment, you may experience personal life changes that will result in changes to your enrollment, or a dependent’s enrollment, in PEBTF benefits. You might move to a new area of the state, get married, or your child becomes too old for coverage.
The PEBTF has eligibility rules for changing plan options, adding a dependent or removing a dependent from coverage. The information is outlined in your Summary Plan Description and in the Plan Document.
New Rules for Making Changes to Your PEBTF Coverage:
You now must make a plan option change within 60 days of a qualifying life event. Effective February 1, 2010, if you do not submit a PEBTF-2 form to your local Human Resource Office within 60 days of the qualifying life event, you will not be able to make a plan change until the next Open Enrollment for a coverage effective date of January 1. This change in rules is being made to comply with tax code regulations governing the pre-tax employee contributions and buy-ups.
You must make a plan option change within 60 days of the following qualifying life events, or else wait until the next Open Enrollment:
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You first become eligible for PEBTF benefits
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You lose other health coverage under your spouse’s plan
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You move to an area outside of your current plan’s service area
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You move to an area where a different plan option is available
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You are enrolled in a plan option that is no longer available because the plan ceases to be offered, the plan’s service area is reduced or there is a substantial reduction in providers in the plan’s network
The Human Resource Office must receive the paperwork for the change within 60 days of the qualifying event. The effective date can be within those 60 days but if the change is retroactive and it results in a cost to you, that amount for the retroactivity will deducted post-tax.
Adding Eligible Dependents:
You may add a dependent for PEBTF medical and/or supplemental coverage due to a qualifying life event. The change must be made within 60 days of the qualifying life event. Effective February 1, 2010, if you do not submit a PEBTF-2 form to your local Human Resource Office within 60 days, you will not be able to add your dependent until the next Open Enrollment period for a coverage effective date of January 1.
You may add a dependent to PEBTF coverage for the following qualifying life events:
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You gain a dependent through birth or adoption
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You get married or enter into a qualifying domestic partnership
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Your dependent loses coverage under another employer’s plan, other than for failure to pay premiums or other cause
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Your dependent loses eligibility for coverage in a Medicare plan, a Medicaid plan or a state children’s health insurance program
New Hires or Re-Hires: You may add your dependents after the completion of six months of employment. The dependents must be added within 60 days of this qualifying event or you will have to wait until the next Open Enrollment period for a coverage effective date of January 1. Dependents can only be added under the same plan option(s) chosen by the employee member.
Do not delay in adding an eligible dependent or you will miss your opportunity and will have to wait until the next Open Enrollment.
You must submit the paperwork to your local Human Resource Office for the change within 60 days of the qualifying event. The effective date can be within those 60 days but if the change is retroactive and it results in a cost to you, that amount for the retroactivity will deducted post-tax.
Removing Dependents:
You are required to remove a dependent from coverage when your dependent is no longer eligible for PEBTF coverage. Examples include:
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You lose a dependent through divorce, termination of a domestic partnership or death. Two related points:
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Separation is not a qualifying life event in Pennsylvania; and
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You are not permitted to remove a spouse from coverage until a divorce is final or until the next Open Enrollment
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Your dependent child no longer meets the requirement for coverage under the PEBTF
Termination of coverage is effective on the date of the qualifying life event so it is important that you notify your local Human Resource Office immediately. Any claims incurred after the date a dependent is no longer eligible, including after a divorce, are your responsibility. The right to COBRA coverage depends on the PEBTF being timely notified of the change.
For more information, contact the PEBTF at 1-800-522-7279.