PEBB ELIGIBLE EMPLOYEES: PEBB Premium Plan Election/Change Form

The majority of eligible employees 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 form to initiate this change can be found on 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 2013 Employee Enrollment Guide, pages 14-15, under “How do I pay for coverage?” The Employee Enrollment Guide can be found at http://www.hca.wa.gov/pebb/Documents/50-100-2013.pdf.

Please contact Benefit Services at 509.335.4521 or email hrs@wsu.edu for questions.

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