New Premium Payment Plan Form

Eligible employees may pay for their share of medical premiums with pre-tax dollars from their salary, as allowed by Internal Revenue Service code Section 125 (also known as the state’s Premium Payment Plan).

During open enrollment or a special open enrollment, employees can choose to waive their participation in the state’s Premium Payment Plan and have their medical premiums deducted after taxes. Employees who previously waived participation in the Premium Payment Plan may re-enroll during open enrollment. The PEBB Program has developed a new form that allows employees to do either—the Premium Payment Plan Election/Change Form. The form can be found on the PEBB 2012 Forms webpage at www.pebb.hca.wa.gov/2012/forms.html or the HRS Benefit Forms webpage at www.hrs.wsu.edu/Benefit+Forms, under the “Medical & Dental” section.

For more information on how IRS code Section 125 applies to PEBB coverage, refer to the 2011 Employee Enrollment Guide, pages 10-11, under “How do I pay for coverage?”. The Employee Enrollment Guide can be found under www.pebb.hca.wa.gov/publications.html.