SCHOOL EMPLOYEE INITIAL ENROLLMENT GUIDE - Your 2020 SEBB Program benefits inside - Highline ...
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SCHOOL
EMPLOYEE
INITIAL
ENROLLMENT
GUIDE
Your 2020 SEBB Program
benefits inside.
HCA 20-0049 (9/19)
Corrections to the School Employee Initial Enrollment Guide Please note the following corrections. • Page 18: Under “What if I’m thinking about retiring?” second paragraph, fifth line, the phone number to contact the PEBB Program should be: 1-800-200-1004. • Page 43: In the “Medical Benefits Comparison” chart, under the “Therapy: Physical, occupational, speech, and neurodevelopmental (per-office visit cost)” column, for the Premera Blue Cross plans, it should read: $40 (45 PT/ST/OT combined/year); $40 (45 NDT/year). • Page 47: In the “Medical Benefits Comparison” chart, under the “Tier 2 (preferred brand-name drugs, high-cost generic drugs, and specialty drugs for UMP)” column for UMP Achieve 1 and UMP Achieve 2, it should read: 30% up to $75 after deductible. • Page 52: In the “Selecting a vision plan” section, under “Vision plan options” the second paragraph should read: Routine eye exams are covered at 100 percent under any of the three plans. In general, the plan covers frames up to $150 every 24 months, and then pays 20 percent of the balance over $150. • Page 53: In the “Vision Benefits Comparison” chart, under the “Lens enhancements” section, the second footnote (2 No out-of-network lens enhancement reimbursement is available) applies to all Davis Vision lens enhancements. • Page 54: In the “Vision Benefits Comparison” chart, under “Children (under age 19) – what you pay for in-network services,” in the “Vision care service (once per calendar year)” section, the Frames benefit should read: $0 up to $150, then 80% of balance over $150 for Davis Vision, EyeMed, and MetLife. • Page 56: Under “When can I enroll in supplemental life insurance?” The third bullet should read: Supplemental life insurance for children, in increments of $5,000 up to $20,000. • Page 64: Under “If this event happens,” the first item should read: “Employee’s independent moves from outside the United States to live within the United States, or from within the United States to live outside of the United States, and that change in residence results in the dependent losing their health insurance.” The notation under “Waive SEBB medical coverage” for this item should read “No.” Updated: 9/23/19
Who to contact for help
Contact the plans directly for help with: Medical plans
• Benefit questions Kaiser Foundation Health Plan of the Northwest
• ID cards Kaiser Permanente NW 1, 2, 3
• Claims (beginning January 1, 2020)
my.kp.org/sebb
• Making sure your health care providers are in
September 1 to December 31, 2019: 1-800-728-2779
the plan’s network
January 1, 2020: 503-813-2000 or
• Choosing a health care provider
1-800-813-2000 (TRS: 711)
• Making sure your prescriptions are covered
Kaiser Foundation Health Plan of Washington
Kaiser Permanente WA Core 1, 2, 3, SoundChoice
Contact your employer’s payroll or benefits
Kaiser Foundation Health Plan of Washington
office for help with:
Options, Inc.
• Benefit eligibility and enrollment questions or Kaiser Permanente WA Options Access PPO 1, 2, 3
changes
kp.org/wa/schools
• Accessing paper forms
September 1 to December 31, 2019: 1-800-728-2779
• Premium surcharges questions
January 1, 2020: 1-888-901-4636
• Updating your contact information (name,
(TTY: 1-800-833-6388 or TRS: 711)
address, phone, etc.)
• Adding or removing dependents
Premera Blue Cross
• Payroll deduction information (including pre-
Premera High PPO, Peak Care EPO, Standard PPO
or post-tax contributions)
premera.com/sebb
1-800-807-7310 (TTY: 1-800-842-5357 or TRS: 711)
Help with SEBB My Account
October 1 to November 15: Uniform Medical Plan (UMP), administered by
1-855-648-3100 Regence BlueShield (for medical questions)
7 a.m. to 9 p.m., Monday through Friday, and UMP Achieve 1, Achieve 2, High Deductible,
10 a.m. to 4 p.m., Saturday for help with: UMP Plus
• SecureAccess Washington (SAW) registration regence.com/ump/sebb
• SEBB My Account screen navigation 1-800-628-3481 (TRS: 711)
• Uploading documents
UMP Plus—Puget Sound High Value Network
pugetsoundhighvaluenetwork.org
1-877-345-8760
UMP Plus—UW Medicine Accountable
Care Network
sebb.uwmedicine.org
1-855-520-9400 (TRS: 711)
Washington State Rx Services (for UMP
prescription drug questions)
regence.com/ump/sebb/benefits/prescriptions
1-888-361-1611 (TRS: 711)
2
Dental plans Additional contacts
DeltaCare, administered by Delta Dental of HealthEquity
Washington Health savings account for UMP High Deductible
deltadentalwa.com/sebb learn.healthequity.com/sebb/hsa
1-800-650-1583 (TTY: 1-800-833-6384) 1-844-351-6853 (TRS: 711)
Uniform Dental Plan, administered by Delta Dental Limeade
of Washington SmartHealth wellness program
deltadentalwa.com/sebb hca.wa.gov/sebb-smarthealth
1-800-537-3406 (TTY: 1-800-833-6384) 1-855-750-8866
Willamette Dental Group Metropolitan Life Insurance Company
MetLife Life and AD&D insurance
sebb.willamettedental.com
1-855-433-6825 (TRS: 711) metlife.com/wshca-sebb
1-833-854-9624 (TTY: 1-833-854-9624)
Vision plans
Navia Benefit Solutions
Medical Flexible Spending Arrangement and
Davis Vision
Dependent Care Assistance Program
davisvision.com/hcasebb
sebb.naviabenefits.com
1-877-377-9353 (TTY: 1-800-523-2847)
1-800-669-3539 or 425-452-3500
EyeMed Vision Care
The Standard Insurance Company
eyemedvisioncare.com/hcasebboe Long-term disability insurance
1-800-699-0993 (TTY: 1-844-230-6498)
standard.com/employee-benefits/
washington-state-hca-sebb
Metropolitan Life Insurance Company
1-833-229-4177 (TTY: 1-833-229-4177)
MetLife Vision Plan
metlife.com/wshca-sebb
1-855-638-3931 (TTY: 1-800-428-4833)
32020 SCHOOL EMPLOYEE INITIAL ENROLLMENT GUIDE
What’s inside
Quick Start Guide ...................................................6
Benefits Fair Schedule ..........................................7
Get Started With SEBB My Account ...............8
Who is eligible for SEBB benefits? ................12
Dependent eligibility...........................................13
Waiving medical coverage ...............................20
Medical Plan Premiums and Deductibles
Available by County .........................................29
Medical Plans Available by School District..35
Medical Benefits Comparison chart...............40
Dental Benefits Comparison chart.................51
Vision Benefits Comparison chart..................53
Life and AD&D insurance .................................55
Long-term disability insurance........................58
Medical FSA and DCAP.....................................59
2020 SEBB Premium Surcharge Attestation
Help Sheet ...........................................................70
Welcome to the SEBB Program
The School Employees Benefits Board (SEBB) Program
was designed with you in mind. Providing you and
your eligible dependents with affordable and equitable
access to quality health insurance and other benefits is
our top priority.
Sign up for email subscription
This guide provides SEBB Program eligibility,
service
enrollment, and benefit information for school
employees and their dependents. In these pages you’ll Get the latest news and updates from the SEBB
learn about the quality benefits that the SEBB Program Program by going paperless. When you receive
has been building since it was established in the SEBB Program mailings by email, it helps reduce
summer of 2017. reliance on paper mailings—and their toll on
the environment. Go to SEBB My Account at
myaccount.hca.wa.gov to sign up during the first
annual open enrollment or any time after
October 1.
4YOUR SEBB PROGRAM BENEFITS
The SEBB Program offers a range of health plans and other benefits, beginning
January 1, 2020, including:
Employer-paid benefits:
Medical insurance
Health savings account (HSA) for those who enroll in UMP High
Deductible (administered by Regence BlueShield)
Wellness programs like SmartHealth and the diabetes prevention program
Dental insurance
Vision insurance
Basic life insurance
Basic accidental death and dismemberment (AD&D) insurance
Basic long-term disability (LTD) insurance
Additional benefits available for you to elect (employee-paid benefits):
Supplemental life insurance
Supplemental AD&D insurance
Supplemental LTD insurance
Medical Flexible Spending Arrangement (FSA)
Dependent Care Assistance Program (DCAP)
5Quick Start Guide
Enrolling in your new SEBB Program benefits is as easy as 1, 2, 3.
Find out if you’re Choose your Enroll using SEBB
eligible benefits My Account
There’s a lot to think about when
Your employer will determine if Once you’ve decided what
selecting your benefits. You need
you are eligible for SEBB benefits benefits and plans you want,
to consider things like provider
based on your specific work head over to
networks, premiums, out-of-
circumstances using the criteria myaccount.hca.wa.gov to log
pocket costs, drug formularies, and
described under Eligibility on in and enroll using SEBB My
if the plan and its providers are
page 12. Account, our online enrollment
available to you.
system.
Generally, you are eligible for
You can also consider additional
SEBB benefits if you work for See Get Started With SEBB My
benefits, like the Medical Flexible
a Washington State school Account on page 8 for details.
Spending Arrangement (FSA),
district or charter school, or are You do not need to do anything
Dependent Care Assistance
a represented employee of an to enroll in basic life, AD&D,
Program (DCAP), supplemental life
educational service district (ESD), and LTD insurance. You will be
insurance, supplemental accidental
and your employer anticipates automatically enrolled.
death and dismemberment
you will work at least 630 hours
(AD&D) insurance, and Details on how to enroll in the
during the school year (September
supplemental long-term disability following benefits are included in
1 through August 31).
(LTD) insurance. this enrollment guide.
Are you enrolling dependents? • Supplemental life and
Use these online tools at
See Dependent eligibility on supplemental AD&D: page 55
hca.wa.gov/sebb-employee to
page 13 for eligibility rules and • Supplemental LTD: page 58
explore your options:
information. Make sure you have • Medical FSA and DCAP: page 59
the right documents to prove their Virtual benefits fair
eligibility. These are available on An online benefits fair experience What if I have other coverage?
page 15. that’s available at your You can waive SEBB medical
convenience. Start out in the coverage if you are enrolled in
If you are not eligible as described virtual exhibition hall to see the other employer-based group
in the eligibility section, you available benefits, then visit plan medical insurance, a TRICARE
may be eligible for some SEBB “booths” to watch informative plan, or Medicare. However, you
Program benefits if your school videos and access additional must enroll in employer-paid
district, charter school, or ESD resources to learn more. dental and vision coverage, as
negotiated eligibility as described well as basic life insurance, basic
ALEX
in WAC 182-30-130. If you are AD&D insurance, and basic LTD
An interactive, online benefits
represented, please check with insurance. See Waiving medical
advisor that provides customized
your union or union contract coverage on page 20.
plan suggestions and side-by-
regarding eligibility. Otherwise, side benefits comparisons for
your employer’s payroll or benefits your consideration, based on your
office will notify you if you are health care needs. First annual open enrollment:
eligible under this provision. October 1 – November
15, 2019
Benefits begin:
January 1, 2020
6SEBB PROGRAM Des Moines Port Angeles
BENEFITS FAIR 4PM–8PM 4PM–8PM
SCHEDULE Highline College, Mt. Peninsula College, J-47
2019
Constance/Mt. Olympus 1502 E Lauridsen Blvd.
rooms
2400 S 240th St.
Moses Lake
Wenatchee
4PM–8PM
4PM–8PM
Columbia Basin Tech
Confluence Tech Center
Center, Commons Bldg.
285 Technology Center Way
900 Yonezawa Blvd.
Bellingham
4PM–8PM Shoreline
Cheney
Bellingham Technical 4:30PM–8PM
4PM–8PM
College, Settlemyer Hall Shoreline Community
Eastern Washington
3028 Lindbergh Ave. College, Dining room
University, LA Hall
16101 Greenwood Ave. N
Yakima 9th and Elm St.
4PM–8PM Vancouver
Howard Johnson Yakima 3PM–8PM
Orchard Room Educational Service Colville
9 N 9th St. District #112 4PM–8PM
2500 NE 65th Ave. AG & Trade Center
317 W Astor Ave.
Mount Vernon
4PM–8PM Seattle
Skagit Valley College, 4PM–8PM Omak
Cardinal Center Bldg C-172 Garfield Community 4PM–8PM
2405 E College Way Center Omak High School
2323 E Cherry St. 20 S Cedar St.
Spokane
4PM–8PM Tacoma
Educational Service 4:30PM–8PM
NOV. Pullman
District #101 (Northeast) UW Tacoma, Phillip Hall
4PM–8PM
4202 Regal St. 1900 Commerce St.
Washington State
University,
Bremerton Compton Union Building
Olympia
4PM–8PM 115 NW State St.,
4PM–8PM
Sheridan Community Suite 112A
South Puget Sound
Center
Community College,
680 Lebo Blvd.
Student Union Building
2011 Mottman Rd SW
Pasco Bellevue
3PM–8PM 4PM–8PM
Columbia Basin College, Bellevue College, L-Bldg
Gjerde Atrium 3000 Landerholm Circle SE
2600 N 20th Ave.
7Get Started With SEBB My Account
SEBB My Account is the exclusive online enrollment system for the School Employees Benefits Board
(SEBB) Program. Eligible school employees can use SEBB My Account on a computer, tablet, or
smartphone to enroll in benefits during the first annual open enrollment, October 1 through November
15, for coverage effective January 1, 2020.
What can I do in SEBB My Account? Setting up your account
• Enroll in SEBB benefits or waive SEBB medical Visit myaccount.hca.wa.gov and click the
• Enroll your eligible dependents in SEBB benefits green Login to SEBB My Account button
under Employee/Subscriber. You’ll be directed
• Upload documents to prove dependent to SecureAccess Washington (SAW). See next
eligibility page to learn about SAW.
• Select your medical, dental, and vision plans
Click Sign up to create a SAW account. (If
• Access vendor websites to enroll in you already have a SAW account, enter your
supplemental (employee-paid) life and username and password and skip to step 5.)
accidental death and dismemberment insurance, Enter your name, email address, a username,
a Medical Flexible Spending Arrangement and password. Remember to save your
(FSA), and Dependent Care Assistance Program username and password in a safe place so you
(DCAP) don’t forget it the next time you log in.
• Enroll in supplemental (employee-paid)
long-term disability insurance Check the box to indicate you’re not a robot,
click Submit, and follow the link to activate
• Attest to premium surcharges (see the next your account.
page for details)
• Request a special open enrollment Check your email for a message from SAW.
Click on the confirmation link, then close the
Account Activated! browser window that
Login notes opens, and return to your original window.
• Google Chrome is the preferred browser, but Follow the instructions on the screen to finish
Edge, Internet Explorer, Firefox, and Safari will creating your account.
also work. You will be redirected back to SEBB My
• Those enrolling in SEBB Continuation Account. Enter your last name, date of birth,
Coverage must use the enrollment forms and last four digits of your Social Security
available at hca.wa.gov/erb under Forms number. Click Verify my information.
& publications, or in the SEBB Continuation Select your security questions and answers.
Coverage Election Notice mailed to them. You’ll be directed to the SEBB My Account
• For more information, check out the SEBB My dashboard.
Account training video series at
hca.wa.gov/sebb-employee.
8How to enroll What information do I need to enroll
Once you login to SEBB My Account, you can dependents?
follow the step-by-step tool at the top of the page For your spouse, state-registered domestic
to guide you through the enrollment process. The partner, or any children, you will need:
four steps are:
• Name
Add your dependents. Enter your • Date of birth
dependents’ information. If you are not adding • Social Security number
dependents, you can skip to step 3. • Verification documents
A list of acceptable documents is available in
Verify your dependents. Your documents
SEBB My Account, as well as at
must be verified and approved before your
hca.wa.gov/sebb-employee and in your
dependents can enroll under your coverage.
enrollment guide.
Upload documents from your computer or
mobile device to verify your dependents’ SecureAccess Washington
eligibility. Acceptable documents (like a birth
or marriage certificate, or recent tax return) SecureAccess Washington (SAW) is the state’s
and file types (PDF, JPEG, JPG or PNG) are secure single sign-on portal for external users. A
listed on the page. SAW account will keep your sensitive information
secure. You can access multiple government
If you are unable to upload documents services online with a single user ID and password
online, you can submit paper documents that you create and manage yourself.
to your payroll or benefits office. HCA may
audit dependent eligibility determinations.
Please make sure to keep the documents you
submitted.
Attest to the premium surcharges. Answer
a series of on-screen questions to determine
whether you’ll be charged the monthly
$25-per-account tobacco use premium
surcharge and, if applicable, the monthly $50
spouse or state-registered domestic partner
coverage premium surcharge.
Select your plans. You can follow a link to
ALEX, the online benefits advisor, to learn
more about which plans might be the best fit
for you. When you’re ready, select your plans
in SEBB My Account by checking the box
next to the medical, dental, and vision plans
you want for you and any dependents you
want to enroll.
If you have other employer-based medical
coverage, TRICARE, or Medicare, you can
waive SEBB medical coverage.
When can I access SEBB My Account?
You can login to SEBB My Account starting
October 1, 2019, which is the first day of the
SEBB Program’s first annual open enrollment.
Open enrollment ends November 15 at 11:59 p.m.,
but you can log in any time, during or after open
enrollment, to check your coverage or request
special open enrollment changes.
9Contents
What happens if I don't enroll in or waive
Who to contact for help .................................... 2
medical coverage?.......................................................20
Welcome to the SEBB Program...................... 4 How do I enroll later if I’ve waived medical
coverage? .......................................................................20
What’s inside......................................................... 4
Your SEBB Program Benefits................................. 5 Monthly Medical Plan Premiums .................... 21
Quick Start Guide .................................................... 6
Benefits Fair Schedule ............................................ 7 Paying for benefits .............................................. 22
Get Started With SEBB My Account .................... 8
What will I have to pay? ..............................................22
How do I pay for coverage? .......................................22
Eligibility.................................................................. 12
Why should I pay my monthly premiums with
Who is eligible for SEBB benefits? ....................... 12 pretax dollars? ..............................................................22
What if I'm eligible for SEBB benefits both as an Would it benefit me not to have a pretax
employee and as a dependent? ........................... 12 deduction? .....................................................................22
Eligibility based on a revision to your anticipated Can I change my mind about having my premium
work pattern or actual hours worked ................. 12 payments withheld pretax?......................................22
Eligibility based on hours worked the previous
two school years.................................................... 12 Premium surcharges... ........................................ 23
Eligibility based on work within one district,
Tobacco use premium surcharge..............................23
charter school, or ESD .......................................... 12
How to report a change in tobacco use .................23
Returning school employees have uninterrupted
Spouse or state-registered domestic partner
coverage ................................................................. 13
coverage premium surcharge ..................................23
Eligibility when changing jobs between SEBB
organizations.......................................................... 13
Choosing your benefits ...................................... 24
When do eligibility and coverage end? ................ 13
Vir tual Benefits Fair ..................................................... 24
Dependent eligibility ........................................... 13
ALEX ................................................................................. 24
Children as defined by WAC 182-31-140 .......... 13
Eligible extended dependents .............................. 14 Selecting a medical plan ................................... 25
Eligible children with disabilities ........................... 14
How can I compare the medical plans? .................25
Surviving dependent eligibility .............................. 14
Medical plan differences to consider .......................25
Proving dependent eligibility ................................. 15
What type of plan should I select? .........................26
Valid dependent verification documents.............. 15
UMP High Deductible with a health savings
account (HSA) ..............................................................27
Enrollment .............................................................. 16
Who is eligible for UMP High Deductible with
When can I enroll? ................................................... 16 an HSA? ........................................................................28
How do I enroll? ....................................................... 16 Are there special considerations if I enroll in an
Additional required forms ...................................... 16 UMP High Deductible mid-year? ..........................28
Am I required to enroll? ......................................... 17 Other features of UMP High Deductible with
What if I don’t waive or enroll?.............................. 17 an HSA ..........................................................................28
Can I enroll in my own account and as a What happens to my health savings account
dependent on someone else’s SEBB account? . 17 when I leave UMP High Deductible? ...................28
Can I enroll in SEBB benefits and also have PEBB How do I find Summaries of Benefits and
insurance coverage as a dependent? ................. 17 Coverage (SBC)? ........................................................28
What if I am entitled to Medicare? ........................ 18 Medical Plan Premiums and Deductibles
What if I’m thinking about retiring? ...................... 18 Available by County ..................................................29
When does coverage begin? ................................. 19 Medical Plans Available by
School District .............................................................35
Waiving medical coverage ................................ 20 Medical Benefits Comparison .................................. 40
How do I waive medical coverage? ...................... 20
10Selecting a dental plan ......................................50 When can I change my Medical FSA or
DCAP election? .............................................................61
Things to keep in mind before you select a dental
plan or provider............................................................50
SmartHealth .......................................................... 61
How do the DeltaCare and Willamette Dental
Group plans work? .....................................................50 Who is eligible for SmartHealth? ..............................61
Dental plan options.......................................................50 What is the wellness incentive? ................................61
How does the Uniform Dental Plan How do I qualify during the first annual open
(UDP) work? .................................................................51 enrollment?.....................................................................61
Dental Benefits Comparison .......................................51 How do I qualify starting in January 2020? ...........61
What if I don’t have internet access? ......................62
Selecting a vision plan........................................ 52 SmartHealth contacts ..................................................62
Vision plan options ......................................................52
Making changes in coverage............................ 62
Vision Benefits Comparison ....................................... 53
How do I make changes in my health plan
Life and AD&D insurance.................................55 coverage? .......................................................................62
What changes can I make at any time?..................62
What are (employer-paid) basic life insurance and
What changes can I make only during the SEBB
basic AD&D insurance? .............................................55
Program annual open enrollment?.........................62
What are (employee-paid) supplemental
What changes can I make during a special open
life and AD&D insurance?.........................................55
enrollment?....................................................................62
What do supplemental life and AD&D insurance
What happens when my dependent loses
cost? ................................................................................56
eligibility? .......................................................................65
When can I enroll in supplemental
What happens to my dependent's coverage
life insurance? ...............................................................56
if they die? .....................................................................65
When can I enroll in supplemental AD&D
What happens when I am required to provide
insurance?...................................................................... 56
health plan coverage for a dependent? ................66
How do I enroll in supplemental life and
supplemental AD&D insurance?.............................56
When SEBB Program coverage ends ........... 66
How do I create an online account
with MetLife? ................................................................ 57 What are my options when coverage ends? .......66
If I leave employment, can I continue life insurance What happens to my Medical FSA funds when
coverage? ....................................................................... 57 coverage ends? ........................................................... 67
What happens to my DCAP funds when
Long-term disability insurance ....................... 58 coverage ends? ........................................................... 67
What happens to my health savings account
What is basic LTD insurance? ...................................58
(HSA) when coverage ends? ...................................68
What is (employee-paid) supplemental LTD
What happens to my life insurance when
insurance?......................................................................58
coverage ends? ............................................................68
What does supplemental LTD insurance
cost? ................................................................................58
Appeals ................................................................... 68
How do I enroll in supplemental LTD
insurance?......................................................................59 How do I appeal a decision made by a plan? .......68
When can I enroll in supplemental LTD How do I appeal a decision from my employer or
insurance?......................................................................59 the SEBB Program? ....................................................68
What is considered a disability? ...............................59 How do I appeal a decision made by a SEBB
What is the maximum benefit period? ...................59 Appeals presiding officer? ........................................68
How can I make sure my personal representative
Medical FSA and DCAP ..................................... 59 has access to my health information?...................68
What is a Medical Flexible Spending
2020 SEBB Premium Surcharge Help
Arrangement (FSA)? ..................................................59
Attestation Help Sheet .................................... 70
How does the Medical FSA work? ........................ 60
What is the Dependent Care Assistance
Nondiscrimination Notice and Language
Program (DCAP)?........................................................60
Access Services.................................................. 72
When can I enroll in Medical FSA and DCAP? .....60
How do I enroll in Medical FSA and DCAP? .........60
11Eligibility
Who is eligible for SEBB benefits? of the school year, but your work circumstance
changes and your employer anticipates at that time
This guide provides a summary of employee
that you will work at least 630 hours during the
eligibility for benefits administered by the SEBB
school year, you become eligible on the date your
Program. Generally, you are eligible for the
work pattern is revised. Your coverage begins the first
employer contribution toward SEBB benefits if you
day of the following month.
work in a school district or charter school, or are
a represented employee of an educational service If you are not anticipated to work 630 hours at the
district (ESD), and your employer anticipates you beginning of the school year, but you do actually
will work at least 630 hours during the school year work 630 hours, you become eligible on the day you
(September 1 through August 31). Paid holidays work your 630th hour. Your coverage begins the first
do not count toward the required hours, except for day of the following month.
certain circumstances when an employee is hired
If you are eligible for the employer contribution
late in the school year.
toward SEBB benefits at the beginning of the year,
Your employer will determine if you are eligible for but your work pattern is revised so that you are
the employer contribution toward SEBB benefits no longer anticipated to work 630 hours during
based on your specific work circumstances the school year, your eligibility for the employer
(see Washington Administrative Code [WAC] contribution and coverage end the last day of the
182-31-040). All eligibility determinations are month in which the change is effective. See page 66
based on rules in chapters 182-30 and 182-31 for information about continuation coverage.
WAC. If discrepancies arise between WACs and this
guide, the WACs take precedence. If you disagree Eligibility based on hours worked the
with the eligibility determination, see Appeals on previous two school years
page 68.
If you worked at least 630 hours in each of the
previous two school years and are returning to the
What if I'm eligible for SEBB benefits both as
same type of position or combination of positions
an employee and as a dependent?
with the same school district, charter school, or
You cannot enroll in medical, dental, or vision under educational service district, you are presumed eligible
two SEBB accounts. If you are an eligible employee for the employer contribution toward SEBB benefits.
and are also eligible as a dependent under your
If your employer does not consider you eligible after
spouse’s, state-registered domestic partner’s, or
having worked at least 630 hours the previous two
parent’s account, you may choose one of these
school years, they must notify you, in writing, of
options:
the specific reason(s) why you are not anticipated
• Waive medical coverage under your own to work at least 630 hours in the current school
account and instead enroll under your spouse’s, year. You have the right to appeal the eligibility
state-registered domestic partner’s, or parent’s determination. See Appeals on page 68.
account. You must still enroll in dental, vision,
basic life insurance, basic AD&D insurance, and Eligibility based on work within one district,
basic LTD insurance under your own account. charter school, or ESD
• Enroll in medical coverage under your own
All of your hours worked as a school employee
account.
within the same school district or charter school, or
Eligibility based on a revision to your as a represented employee of the same educational
anticipated work pattern or actual hours service district (ESD) count in the calculation of hours
worked to determine your eligibility. You cannot “stack”
hours from different school districts, charter schools,
If you are determined not eligible for the employer
or ESDs to reach the eligibility level of 630 hours.
contribution toward SEBB benefits at the beginning
For more details on eligibility, refer to Washington Administrative Code (WAC) 182-31-040 at
hca.wa.gov/sebb-rules.
12Returning school employees have in WAC 182-30-130. If you are represented, please
uninterrupted coverage check with your union or union contract regarding
eligibility. Otherwise, your employer’s payroll or
Once you are enrolled in the SEBB Program, you will
benefits office will notify you if you are eligible
receive uninterrupted coverage from one school
under this provision.
year to the next when you return at the start of the
next school year to the same school district, charter
school, or as a represented employee of the same
ESD, as long as you are still anticipated to work 630 Dependent eligibility
hours in the coming school year.
You may enroll the following dependents:
Eligibility when changing jobs between
SEBB organizations • Your legal spouse
• Your state-registered domestic partner (as
Once enrolled in the SEBB Program, you will have
defined in WAC 182-30-020)
uninterrupted coverage when moving from one
• Your children (as defined in WAC 182-31-140)
SEBB organization to another within the same month
through the last day of the month in which they
or a consecutive month if you are eligible for the
become age 26
employer contribution towards SEBB benefits in
• Your extended dependent children who meet
the position you are leaving and are anticipated to
specified eligibility criteria (see Eligible extended
be eligible for the employer contribution toward
dependents on page 14)
SEBB benefits in the new position. SEBB insurance
• Your children of any age with a disability (see
coverage elections also remain the same if you have
Eligible children with disabilities on page 14)
a break in employment that does not interrupt their
employer contribution toward your SEBB insurance If you have dependents currently enrolled in medical,
coverage. You may make a change if you have a dental, or vision under your school district, charter
special open enrollment event. See page 63. school, or ESD group insurance on December 31,
2019 who are not eligible as dependents, SEBB
When do eligibility and coverage end? Program benefits may be available. (See What are my
options when coverage ends? on page 66 for details.)
Your eligibility for the employer contribution toward
SEBB benefits ends the last day of the school
Children as defined by WAC 182-31-140
year (August 31). Your eligibility for the employer
contribution will end earlier if: This definition includes:
• Your employer terminates your employment. • Your children, based on establishment of a
Eligibility and coverage ends the last day of parent-child relationship as described in RCW
the month in which the termination notice is 26.26A.100, except when parental rights have
effective. been terminated
• You resign. Eligibility and coverage ends the last • Children of your spouse, based on establishment
day of the month in which your resignation is of a parent-child relationship as described in
effective. RCW 26.26A.100, except when parental rights
• Your work pattern is revised and your employer have been terminated
no longer anticipates you will work 630 hours • Children for whom you have assumed a
during the school year. Coverage ends the legal obligation for total or partial support in
last day of the month in which the change is anticipation of adoption of the child
effective. See page 66 for information about • Children of your state-registered domestic
continuation coverage. partner, based on establishment of a
parent-child relationship as described in RCW
Employees eligible for locally negotiated 26.26A.100, except when parental rights have
benefits been terminated
• Children specified in a court order or divorce
If you not eligible as described in this eligibility
decree for whom you have a legal obligation to
section, you may be eligible for some SEBB
provide support or health care coverage
Program benefits if your school district, charter
school, or ESD negotiated eligibility as described
(continued)
13
13Eligible extended dependents • Visual verification of a document from the
SEBB organization’s current health plan
Eligible school employees enrolled in SEBB benefits
finding the dependent child eligible at age 26
may enroll a child up to age 26 that is an extended
or older based on disability that occurred prior
dependent in the legal custody or legal guardianship
to attainment of age 26.
of the school employee, the school employee's
• For a child with a disability who will turn age
spouse, or the school employee's state-registered
26 on or before December 31, 2019, the SEBB
domestic partner. The legal responsibility is
organization can continue to verify and attest
demonstrated by a valid court order and the child's
through December 31, 2019.
official residence with the custodian or guardian.
An extended dependent child does not include a If you are not able to obtain an attestation from your
foster child unless the school employee, the school SEBB organization while requesting enrollment of
employee’s spouse, or the school employee’s your child, follow the process for initial certification:
state-registered domestic partner has assumed
• You must submit proof of the disability to the
a legal obligation for total or partial support in
SEBB Program.
anticipation of adoption.
• The SEBB Program, with input from your medical
plan (if applicable), will verify the disability
Eligible children with disabilities
of a child beginning at age 26, but no more
Eligible children also include children of any age with frequently than annually after the two-year
a developmental or physical disability that renders period following the child’s 26th birthday, which
the child incapable of self-sustaining employment will require recertification from you and your
and chiefly dependent upon the employee for dependent’s provider.
support and maintenance, provided the condition • If the SEBB Program does not receive your
occurred before age 26. certification form within the time allowed, the
child will no longer be covered. To prevent a
The SEBB Program, with input from your medical
gap in coverage you must submit all required
plan (if applicable), will verify the disability of a child
documentation within the first annual open
beginning at age 26, but no more frequently than
enrollment and if your child is turning age 26 in
annually after the two-year period following the
the year of 2020 you must send documentation
child’s 26th birthday, which will require certification
prior to your child’s 26th birthday to prevent a
from you and your dependent’s provider.
gap in coverage. If your child remains eligible,
During the SEBB Program’s first annual open you can enroll your child if you experience a
enrollment, October 1 through November 15: special open enrollment or during the next
annual open enrollment.
• If you are a currently enrolled member of
the Public Employees Benefits Board (PEBB)
A child with a developmental or physical disability
Program, you are not required to recertify your
age 26 or older who becomes self-supporting
child. Your certification will transition to the SEBB
is not eligible as of the last day of the month
Program. Nothing further will be required until
they become capable of self-support. If the
the next recertification period.
child becomes capable of self-support and later
• If you and your dependent child with a
becomes incapable of self-support, the child does
disability are currently enrolled in your SEBB
not regain eligibility as a child with a disability.
organization’s (school district, charter school,
or participating educational service district) You must notify the SEBB Program, in writing, no
health plan (and not enrolled in PEBB benefits), later than 60 days after the date your child is no
your payroll or benefits office is authorized to longer eligible.
attest to your dependent child’s disability status
if the child is enrolled based on eligibility as a
Surviving dependent eligibility
dependent child age 26 or older with a disability.
The attestation may be based on either of the If you die, your dependents will lose their eligibility
following: for the employer contribution toward SEBB Program
• An existing SEBB organization enrollment benefits. They may be eligible to enroll in Public
record, finding the dependent child eligible at Employees Benefits Board (PEBB) Program retiree
age 26 or older based on disability that insurance coverage as a survivor, instead of enrolling
occurred prior to attainment of age 26.
14in SEBB Program continuation coverage. See page 66 Documents to enroll a state-registered domestic
for more about continuation coverage. partner
Provide a copy of (choose one):
Proving dependent eligibility
• A certificate/card of state registered domestic
When you enroll dependents on your SEBB Program
partnership or legal union and evidence that
coverage, you are required to provide proof of their
the partnership is still valid (e.g., utility bill dated
eligibility with a document that shows they are
within the past two months showing both your
dependents, even if you have previously verified their
and your state-registered domestic partner’s
eligibility with your employer. These documents must
names, a bank statement dated within the past
be approved (verified) by your payroll or benefits
two months [black out financial information]
office during the first annual open enrollment. You
showing both your and your partner's names)
can upload your documents for verification in SEBB
• Petition for invalidity (annulment) of
My Account (see page 8 to 9), or provide them
state-registered domestic partnership or legal
directly to your employer’s payroll or benefits office.
union
There is an exception for school employees who • Petition for dissolution of state-registered
were previously enrolled in the Public Employees domestic partnership or legal union
Benefits Board (PEBB) Program. If you are enrolled in • Legal separation notice of state-registered
PEBB benefits as of December 31, 2019, you do not domestic partnership or legal union
need to provide dependent verification documents if • Valid J-1 or J-2 visa issued by the U.S.
your enrolled dependents have already been verified government
by your employer.
If enrolling a state-registered domestic partner, also
attach a completed Declaration of Tax Status form
Valid dependent verification documents
to indicate whether your state-registered domestic
Birth certificates, adoption decrees, tax returns, and partner qualifies as a dependent for tax purposes
parenting plans are among the types of documents under Internal Revenue Code (IRC) Section 152, as
you can use to prove eligibility. All documents modified by IRC Section 105(b).
must be submitted in English. Documents written
Documents to enroll children
in a foreign language must include a translated
Provide a copy of (choose one):
copy prepared by a professional translator and be
notarized. • The most recent year’s federal tax return that
includes the child as a dependent and lists
Documents to enroll a spouse
them as a son or daughter (black out financial
Provide a copy of (choose one):
information). You can submit one copy of your
• Your most recent year’s jointly filed federal tax tax return as a verification document for all
return that lists the spouse (black out financial family members listed who require verification.
information) • Birth certificate (or hospital certificate with the
• Your and your spouse’s most recent year's child’s footprints on it) showing the name of the
federal tax returns if filed separately (black out parent who is the subscriber, the subscriber’s
financial information) spouse or state-registered domestic partner.
• A marriage certificate and evidence that the • If the dependent is the subscriber’s stepchild,
marriage is still valid (e.g., a utility bill dated the subscriber must also verify the spouse or
within the past two months showing both your state-registered domestic partner in order to
and your spouse’s names, a bank statement enroll the child, even if not enrolling the spouse
dated within the past two months [black out or state-registered domestic partner in SEBB
financial information] showing both your and insurance coverage.
your spouse's names) • Certificate or decree of adoption showing the
• Petition for dissolution of marriage name of the parent who is the subscriber, the
• Legal separation notice subscriber’s spouse or state-registered domestic
• Defense Enrollment Eligibility Reporting System partner
(DEERS) registration • Court-ordered parenting plan
• Valid J-1 or J-2 visa issued by the U.S. • National Medical Support Notice
government
(continued)
15• Defense Enrollment Eligibility Reporting System • Upload dependent verification documents.
(DEERS) registration • Make attestations for the tobacco use premium
• Valid J-2 visa issued by the U.S. government surcharge for yourself and each dependent
you want to enroll under your coverage and,
See Additional required forms on this page for
if applicable, the spouse or state-registered
information regarding requirements for an extended
domestic partner coverage premium surcharge.
dependent, state-registered domestic partner or
• Download a summary of your coverage
their eligible children, or child with a disability.
elections.
If you disagree with a specific eligibility decision or You do not need to do anything to enroll in
denial, you can appeal. See Appeals on page 68. basic life insurance, basic accidental death
and dismemberment (AD&D) insurance, and
basic long-term disability insurance; you will
be automatically enrolled. You will also be
Enrollment automatically enrolled as a participant under the
premium payment plan (see How do I pay for
When can I enroll? coverage? on page 22).
If you are eligible for SEBB Program benefits, you
Additional required forms
must enroll during the SEBB Program’s first annual
open enrollment, October 1 through November Declaration of Tax Status: Employees must also
15, 2019. complete and submit this form when enrolling a
state-registered domestic partner or their eligible
How do I enroll? children regardless of tax status.
The easiest way to enroll is online, using SEBB My Certification of a Child With a Disability: After
Account. You can access SEBB My Account using turning age 26, your child may be eligible for
a desktop computer or mobile device. See Get enrollment under your SEBB Program health plan
Started With SEBB My Account on pages 8 to 9 to if your child’s developmental or physical disability
learn how to set up your account and enroll online. occurred before age 26, and they are incapable of
You cannot access SEBB My Account and enroll self-sustaining employment and chiefly dependent
online until October 1, 2019. Online enrollment on you for support and maintenance.
through SEBB My Account must be completed by
Extended Dependent Certification: To be
11:59 p.m. on November 15, 2019.
considered for enrollment in SEBB Program
If you cannot access the internet, use the School coverage as an extended dependent, all of the
Employee Enrollment Form, available from your following conditions must be met:
payroll or benefits office. You cannot submit
• The extended dependent must not be your
enrollment forms before October 1, 2019. Your
child through birth, adoption, marriage, or a
employer's payroll or benefits office must receive
state-registered domestic partnership.
any paper forms by November 15, 2019.
• You, your spouse, or your state-registered
When open enrollment begins on October 1, log in domestic partner are the legal guardian or have
to SEBB My Account at myaccount.hca.wa.gov to: legal custody of the child.
• The child’s official residence is with the guardian
• Choose your medical, dental, and vision
or custodian.
insurance plans.
• You have provided the SEBB Program with a
• Enroll in (employee-paid) supplemental
valid court order showing that you, your spouse,
long-term disability (LTD) insurance
or your state-registered domestic partner have
• Access vendor websites to enroll in
legal custody or guardianship.
(employee-paid) supplemental life insurance,
• The child is not a foster child unless you, your
supplemental accidental death and
spouse, or your state-registered domestic
dismemberment (AD&D) insurance, Medical
partner has assumed a legal obligation for total
Flexible Spending Arrangement (FSA), and
or partial support in anticipation of adoption.
Dependent Care Assistance Program (DCAP).
• Enroll your eligible dependents.
16If you are defaulted, you cannot change plans
Also complete this
If enrolling a: or enroll your eligible dependents until the next
form:
SEBB Program annual open enrollment in fall
State-registered Declaration of Tax Status 2020, unless you have a special open enrollment
domestic partner or event that allows the change. You can change
their eligible children your tobacco use attestation at any time through
SEBB My Account or by submitting a 2020 SEBB
Dependent child with Certification of a Child
Premium Surcharge Attestation Change Form
a disability (age 26 With a Disability
to your payroll or benefits office. See Premium
and older)
surcharges on page 23.
Extended (legal) Extended Dependent
dependent child Certification Can I enroll in my own account and as a
dependent on someone else’s SEBB account?
Forms are available at hca.wa.gov/
No. A person may be enrolled in only one SEBB
sebb-employee under Forms & publications.
medical, dental, and vision plan. You can waive
medical coverage for yourself and enroll as a
Am I required to enroll? dependent on your spouse’s, state-registered
domestic partner’s, or parent’s SEBB medical
Yes. If your employer determines that you are
coverage. However, you must enroll in dental and
eligible, you are required to enroll. However, you
vision coverage, as well as basic life insurance,
may waive enrollment in SEBB medical coverage if
basic accidental death and dismemberment
you are enrolled in other employer-based group
insurance, and basic long-term disability insurance
medical insurance, a TRICARE plan, or Medicare. In
under your own account if eligible. See Waiving
order to waive SEBB medical coverage you must
medical coverage on page 20.
actively indicate your intention to do so in SEBB
My Account or by submitting an enrollment form
Can I enroll in SEBB benefits and also have
to your payroll or benefits office. If you waive SEBB
PEBB insurance coverage as a dependent?
medical insurance, you must still enroll in SEBB
dental, vision, basic life insurance, basic accidental Yes. If you are enrolled in SEBB Program benefits,
death and dismemberment (AD&D) insurance, and and your spouse or state-registered domestic
basic long-term disability (LTD) insurance. partner or parent is enrolled in Public Employees
Benefits Board (PEBB) Program benefits, you
If you waive medical coverage for yourself, you
can be enrolled in both programs. Your primary
cannot enroll your eligible dependents in SEBB
coverage would be through the SEBB Program and
medical coverage, but you can enroll them in SEBB
your secondary coverage would be through the
vision and dental. See Waiving medical coverage
PEBB Program, which is also administered by the
on page 20 for instructions and timelines.
Washington State Health Care Authority.
What if I don’t waive or enroll? For example, if you are enrolled in the SEBB
Program covering yourself as well as your
If you are eligible for the employer contribution
spouse or state-registered domestic partner as
toward SEBB benefits, but do not waive or enroll
a dependent, and your spouse is enrolled in the
in SEBB Program medical coverage during the
Public Employees Benefits Board (PEBB) Program
first annual open enrollment, you will be enrolled
and covers you as a dependent, or vice versa, you
by default as a single subscriber in UMP Achieve
and your spouse would not incur the monthly
1 (administered by Regence BlueShield) as your
$50 spouse or state-registered domestic partner
medical plan, Uniform Dental Plan, MetLife vision
coverage premium surcharge as long as you
insurance, basic life insurance, basic accidental
attest that it does not apply to you. However, if
death and dismemberment (AD&D) insurance,
your spouse or state-registered domestic partner
and basic long-term disability (LTD) insurance.
waives their PEBB medical coverage and enrolls
Your dependents will not be enrolled. You will
on your account, you will be charged the monthly
be charged a monthly $33 premium for medical
$50 spouse or state-registered domestic partner
coverage as well as a $25-per-account monthly
coverage premium surcharge in addition to
tobacco use premium surcharge. See Waiving
your monthly medical premium. Alternatively if
medical coverage on page 20.
(continued)
17you waive enrollment in SEBB medical and your you do not have to enroll in Medicare Part D. If
spouse or state-registered domestic partner you enroll in Medicare Part D, your SEBB medical
enrolls you as a dependent on their PEBB account, plan may not coordinate prescription drug benefits
they will be charged the monthly $50 spouse with your Medicare Part D plan.
or state-registered domestic partner coverage
If you lose or terminate SEBB medical coverage
premium surcharge in addition to their monthly
To avoid paying a higher premium, you should
medical premium. See Premium surcharges on
enroll in a Medicare Part D plan within 63 days
page 23.
after your SEBB medical coverage ends. If you
don’t enroll within the 63-day deadline, your
What if I am entitled to Medicare?
Medicare Part D plan’s monthly premium may
Medicare Parts A and B increase by 1 percent or more for every month you
When you or your covered dependents become don't have creditable coverage.
entitled to Medicare Part A and Part B, the person
If you enroll or terminate (cancel) enrollment
entitled to Medicare should contact the nearest
in Medicare Part D, you may need a “notice of
Social Security office to ask about the advantages
creditable coverage” to prove to Medicare or
of immediate or deferred enrollment in Medicare
the prescription drug plan that you have had
Part B. Find contact information for your local
continuous prescription drug coverage to reenroll
office at ssa.gov/agency/contact.
at a later date without penalties. You can call
For employees and their enrolled spouses age 65 the SEBB Program at 1-800-200-1004 (select
and older, SEBB medical plans provide primary menu option 6) to request a notice of creditable
coverage, and Medicare ordinarily provides coverage.
secondary coverage. You may choose to waive
For questions about Medicare Part D, call the
your enrollment in SEBB medical coverage and
Centers for Medicare & Medicaid Services at
have Medicare as your medical coverage. However,
1-800-633-4227 or visit medicare.gov.
you will remain enrolled in SEBB dental, vision,
basic life insurance, basic AD&D insurance, and
What if I’m thinking about retiring?
basic LTD insurance. See Waiving medical coverage
on page 20. The SEBB Program does not offer retiree insurance
coverage. Retiree insurance coverage for SEBB
Medicare Part B
members is offered through the Public Employees
In most situations, you and your spouse can elect
Benefits Board (PEBB) Program. When you become
to defer Medicare Part B enrollment, without
entitled to Medicare Part A and Part B, you must
penalty, as long as you are an active employee
enroll and maintain enrollment in Medicare Part
enrolled in a group medical plan. Contact your
A and Part B to enroll or remain eligible for PEBB
nearest Social Security office for information on
retiree insurance coverage. Be sure you understand
deferring or reinstating Medicare Part B. Make sure
the Medicare enrollment timelines, especially if
you understand the Medicare enrollment timelines
you are leaving employment within a few months
to avoid late enrollment penalties.
of becoming eligible for Medicare or are in your
If your Medicare entitlement is due to a disability, Medicare Initial Enrollment Period (IEP) and want
contact a Social Security Office regarding deferred to enroll in PEBB retiree health plan coverage.
enrollment.
When you plan to terminate your employment
Medicare Part D: Annual notice of creditable and want to enroll in PEBB retiree insurance
prescription drug coverage coverage, you can contact the PEBB Program
Medicare Part D is available to people enrolled in about 90 days prior to terminating employment at
Medicare Part A and/or Part B. Part D coverage 1-800-200-1004 (select menu option 5) to ask
provides prescription drug benefits through general PEBB retiree insurance questions. You can
private plans. These plans provide at least a also request a PEBB Retiree Enrollment Guide or
standard level of coverage set by Medicare. download it from the link below. You have 60 days
All SEBB medical plans provide creditable from the date your employer-paid SEBB coverage
prescription drug benefits that are as good as or or COBRA coverage ends for the PEBB Program
better than Medicare Part D coverage. When you to receive your application for retiree insurance
become entitled to Medicare Part A and Part B, coverage. Once your form is received, PEBB
18 Text in red updated as of 9/23/19You can also read
