Integrated Service Center

Other Special Open Enrollment Events

Other Special Open Enrollment Event Workday Paper Form
HSA Enroll/Change X
Tobacco Use Attestation – Change in Medical Surcharge X
Spousal Premium Surcharge Reattestation X
DRS Investment Manager X
Optional LTD (outside of initial 31 day eligibility) X
PEBB Email Subscription X

HSA Enroll/Change

A Health Savings Account (HSA) allows you to put aside pre-tax funds for healthcare expenses.

To Change Your Election(s):
In Workday, initiate an HSA Enroll Change Change Benefit Event.

Tobacco Use Attestation – Change in Medical Surcharge

You can report a change any time you or any enrolled family members you reported as using tobacco products do any of the following:

  • Stop using tobacco products for at least two months.
  • Enroll in your PEBB medical plan’s tobacco cessation program (for ages 18 and older).
  • Access the information and resources in Smoke free Teen (for ages 13-17).

You must also report a change if you or any enrolled family member age 13 or older starts using a tobacco product, or stops participating in your PEBB medical plan’s tobacco cessation program.

To Change Your Election(s):
In Workday, initiate a Change Tobacco Use Attestation Surcharge Change Benefit Event.

Spousal Premium Surcharge Reattestation

You can only report a change to this surcharge in the following situations:

  • When adding a spouse or state-registered domestic partner: To your PEBB Program medical benefits.
  • During the PEBB Program’s annual open enrollment: November 1–30.
  • Within 31 days of the day you regain eligibility for the employer contribution: Toward PEBB Program benefits.

Within 60 days of the event: If there is a change in your spouse’s or state-registered domestic partner’s employer-based group medical insurance.

To Change Your Election(s):
In Workday, initiate a Change Spouse or Partner Premium Surcharge Change Benefit Event.

Proof of event is required
A PEBB member must provide proof there is a change in the spouse’s or state-registered domestic partner’s employer-based group medical. Valid documents for evidence of change in employer-based group medical are listed below. This list is not all inclusive.
Letter from the spouse or state-registered domestic partner’s plan or employer’s personnel, payroll, or benefits office
Newsletter announcing change in spouse or state-registered domestic partner’s rates.

DRS Investment Manager

If you are enrolled in a PERS3 Retirement Plan, you may elect to change your DRS Investment option in Workday.

To Change Your Election(s):
In Workday, initiate a DRS Investment Manager Change Benefit Event.

Optional LTD (outside of initial 31 day eligibility)

You can build on your basic coverage with the optional LTD Plan. You may need to provide evidence of insurability, depending on what coverage you apply for and when. Optional LTD provides:

  • Benefit: 60 percent of the first $10,000 of your pre-disability earnings, reduced by any deductible income, and any benefits paid under the basic plan.
  • Minimum: $50/month
  • Maximum: $6,000/month

To Change Your Election(s):
Submit a completed Long Term Disability (LTD) Enrollment Change Form and Optional LTD Evidence of Insurability Form to the ISC.

PEBB Email Subscription

If you are enrolled in PEBB, you may elect to subscribe/unsubscribe of PEBB emails in Workday.

To Change Your Election(s):
In Workday, initiate a PEBB Email Subscription Change Benefit Event.