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Rules for Making Changes to Your PEBTF Health Care Coverage

Effective July 1, 2011, the PEBTF has modified its eligibility rules for enrolling in coverage and adding eligible dependents. The rules for removing dependents, changing plans, or dropping coverage have not changed. These changes still require a Qualifying Event.

Rules for Making Changes to Your PEBTF Coverage:

Effective July 1, 2011, employees who are eligible for PEBTF health care coverage will be able to enroll at any time without a Qualifying Event. The effective date cannot be more than sixty days retroactive. To enroll in a PEBTF health plan, the employee must submit a PEBTF-2 Enrollment/Change Form and, if electing to add dependents, a PEBTF-2A Coordination of Benefits form, and a PEBTF-11 Declaration of Spouse/Domestic Partner Health Coverage along with supporting eligibility documentation (original marriage certificate to add spouse, original birth certificates to add children, domestic partnership verification statement to add domestic partner) to the Office of Human Resources, Sutton Hall, Room G-8.

Adding Eligible Dependents:

Effective July 1, 2011, you may add a dependent for PEBTF medical and/or supplemental coverage at any time without a Qualifying Event. The effective date cannot be more than sixty days retroactive. Dependents who were terminated from coverage due to the employee’s failure to submit the required documentation (attestation form, birth certificate, etc.) may be reinstated if the employee submits the required documenation to the PEBTF. If the involuntary termination occurred more than six months from the current date, an appeal must be submitted to the PEBTF’s board of trustees.

Removing Dependents:

You are required to remove a dependent from coverage when your dependent is no longer eligible for PEBTF coverage. Examples include:

  • You lose a dependent through divorce, termination of a domestic partnership, or death. Two related points:
    • Separation is not a qualifying life event in Pennsylvania.
    • You are not permitted to remove a spouse from coverage until a divorce is final or until the next Open Enrollment.
  • Your dependent child becomes eligible for health insurance coverage through his/her employer or, if married, his/her spouse’s employer.

Termination of coverage is effective on the date of the qualifying life event, so it is important that you notify the Office of Human Resources 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.

  • Human Resources Office
  • Sutton Hall, Room G8
    1011 South Drive
    Indiana, PA 15705
  • Phone: 724-357-2431
  • Fax: 724-357-2685
  • Office Hours
  • Monday through Friday
  • 8:00 a.m.–4:30 p.m.