Determine Insurance Eligibility


Insurance eligibility is determined from the employee’s appointment, not the employee themselves.

Use the steps below to help determine if your new hire is eligible for insurance or not.

  1. To determine if your new employee is insurance eligible or not with your agency, you will want to access the PEBB website and choose the appropriate “A” worksheet. For example, if your employee is a new hire or a rehire to state service, you will use “A1” but if they are a direct transfer from another state agency with no break in state service, you will use “A5."
  2. Fill out all tabs of the appropriate worksheet(s) and print a copy of the ACA Status tab and the Employee (print version) tab. On the very last page is a place for both you and the employee to sign stating that the employee understands that they are either insurance eligible or insurance ineligible. Please be sure to scan the signed version to DES Payroll.*Always use Y1 or N1 on the first tab unless you have a true seasonal employee. Non-permanent employees are not seasonal employees.
  3. Depending on the answer to the questions, the third tab, Employee (print version) will tell you and the employee if they are insurance eligible or not. This tab will also give the exact dates of when their medical forms are due along with when their insurance effective date is.

If you ever need guidance on these worksheets please feel free to reach out to Small Agency HR.