Open Enrollment: Premium Payment Plan Election/Change Form

The majority of eligible employees pay for their 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 the annual Open Enrollment period 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 post-tax. Employees who previously waived participation in the Premium Payment Plan may re-enroll during open enrollment. To make this change, please complete and submit the Premium Payment Plan Election/Change Form to HRS Pullman by November 30, 2020.

Due to continued social distancing efforts, completed forms can be submitted in the following no-contact ways:

  • Fax to 509-335-1259
  • Email to hrs.benefits@wsu.edu with SSNs removed (please include your WSU ID instead)
  • USPS Mail to 139 French Administration BuildingPO Box 641014Pullman, WA 99164-1014
  • Campus Mail to 1014

For more information on how IRC Section 125 applies to PEBB coverage, refer to the 2021 Employee Enrollment Guide, page 19, under Paying for Benefits.

Please contact HRS Benefits at 509-335-4521 or email hrs.benefits@wsu.edu if you have questions.

The Notices and Announcements section is provided as a service to the WSU community for sharing events such as lectures, trainings, and other highly transactional types of information related to the university experience. Information provided and opinions expressed may not reflect the understanding or opinion of WSU. Accuracy of the information presented is the responsibility of those who submitted it. The self-uploaded posts are reviewed for compliance with state statutes and ethics guidelines but are not edited for spelling, grammar, or clarity.

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