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    v1.0.31
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyWashington HCA Dependent Policy Update | OpenPayer
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    CurrentWashington State Health Care AuthorityPolicy 31-1

    Verifying dependent eligibility before enrollment

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    Governs the documents and verification processes used by the Public Employees Benefits Board Program before enrolling a person as a dependent under a subscriber's PEBB health plan coverage.

    Policy Summary
    PayerWashington State Health Care Authority
    PolicyVerifying dependent eligibility before enrollment
    Policy CodePolicy 31-1
    Change TypeNo material change
    Effective DateJan 1, 202749d
    Next Review DateN/A
    Key ActionRequire subscribers to provide documentation verifying a person's relationship to the subscriber before enrolling that person as a dependent under the subscriber's PEBB health plan coverage, unless an exception applies.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    3Dependent relationship categories
    2Exceptions to standard documentation
    6 monthsEvidence recency period
    EnglishRequired document language

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Dependent Verification Before Enrollment

    Verification and Documentation Procedures

    Documentation Required

    Obtain Relationship Verification

    Before enrolling a person as a dependent under the subscriber’s PEBB health plan coverage, obtain documentation verifying the person’s relationship to the subscriber, except as provided for extended dependent children and previously verified SEBB dependents.

    Documentation Required

    Process Extended Dependent Children

    Apply the extended-dependent-child certification process under the applicable WAC provisions and PEBB Program Administrative Policy 37-1 when determining eligibility for extended dependent children.

    • WAC 182-12260
    • WAC 182-12-262
    • PEBB Program Administrative Policy 37-1
    Note

    Reuse Prior SEBB Verification

    When a subscriber moves from SEBB Program coverage to PEBB Program coverage and requests enrollment of eligible dependents previously verified under SEBB, do not require dependent verification documents. Use the dependent verification data previously verified by SEBB.

    Note

    Maintain Ongoing Verification Authority

    The PEBB Program reserves the right to review a dependent’s eligibility at any time.

    Documentation Required

    Apply Document Submission Rules

    Apply the PEBB Program’s document submission rules when collecting dependent verification materials.

    • Copies of documents referenced in the valid-dependent-verification table are acceptable.
    • Other documents approved by the PEBB Program may be used for dependent verification.
    • Submit all documents in English. Documents written in a foreign language must be accompanied by a translated copy produced by a professional translator.
    Policy Summary
    PayerWashington State Health Care Authority
    PolicyVerifying dependent eligibility before enrollment
    Policy CodePolicy 31-1
    Change TypeNo material change
    Effective DateJan 1, 202749d
    Next Review DateN/A
    Key ActionRequire subscribers to provide documentation verifying a person's relationship to the subscriber before enrolling that person as a dependent under the subscriber's PEBB health plan coverage, unless an exception applies.
    SourceLink
    On This Page
    Dependent Verification Before EnrollmentVerification and Documentation Procedures