Integrated Service Center

Other Special Open Enrollment Events

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

HSA Enroll/Change

Event Description How to Change Your Election(s)
Health Savings Account allows you to put aside pre-tax funds for healthcare expenses Workday: Initiate an HSA Enroll Change Change Benefit Event

Tobacco Use Attestation – Change in Medical Surcharge

Event Description How to Change Your Election(s)
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.

Workday: Initiate a Change Tobacco Use Attestation Surcharge Change Benefit Event

Spousal Premium Surcharge Reattestation

Event Description How to Change Your Election(s)
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.

Workday: Initiate a Change Spouse or Partner Premium Surcharge Change Benefit Event

Proof of Event 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

Event Description How to Change Your Election(s)
If you are enrolled in a PERS3 Retirement Plan, you may elect to change your DRS Investment option in Workday. Workday: Initiate a DRS Investment Manager Change Benefit

Optional LTD (outside of initial 31 day eligibility)

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

PEBB Email Subscription

Event Description How to Change Your Election(s)
If you are enrolled in PEBB, you may elect to subscribe/unsubscribe of PEBB emails in Workday. Workday: Initiate a PEBB Email Subscription Change Benefit Event in Workday