SEBB rules and policies
The SEBB Program follows the rules in Washington Administrative Code (WAC). Our administrative policies describe how we implement a law or rule affecting participation in SEBB Program benefits.
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Stay up-to-date with SEBB Program rule making
SEBB Program law
You can find the SEBB Program's existing law in chapter 41.05 of the Revised Code of Washington (RCW).
SEBB Program rules
The SEBB Program follows the rules in Washington Administrative Code (WAC) chapters:
Below are links to the detailed rules for circumstances most common to school employees.
- How do school employees establish eligibility and when does SEBB insurance coverage begin?
- Who are eligible dependents?
- When may subscribers enroll or remove eligible dependents?
- Is dual enrollment in SEBB and PEBB prohibited?
- When may a school employee waive enrollment in SEBB medical and when may they enroll in SEBB medical after having waived enrollment?
- When may subscribers change health plans?
- When do benefits end?
- SEBB appeals rules
SEBB Program policies
The SEBB Program's administrative policies describe how we implement a law or rule affecting participation in SEBB Program benefits. The statements made in these documents reflect our interpretations of the eligibility and enrollment rules.
Employee eligibility and enrollment
| Number | Title | Effective Date |
|---|---|---|
| 11-1 |
Providing a notice to a school employee |
|
| 11-3 | Correcting School Employees Benefits Board Organization and contracted vendor enrollment errors | |
| 12-1 | Determining the first day of school for SEBB organizations | |
| 19-1 |
Termination due to loss of eligibility or enrollment error |
|
| 19-1A | Addendum - Termination due to loss of eligibility or enrollment error: School employee | |
| 19-1B | Addendum - Termination due to loss of eligibility or nonpayment: Self-pay subscriber |
Dependent eligibility and enrollment
| Number | Title | Effective Date |
|---|---|---|
| 31-1 | Verifying dependent eligibility before enrollment | |
| 31-2 | Use of SEBB Spousal Plan Calculator | |
| 33-1 | Verifying legal union's residency status | 1/1/2023 |
| 36-1 | Certifying eligibility for a dependent child with a disability who is age 26 or older | |
| 37-1 | Certifying eligibility for an extended dependent child |
Special open enrollment
|
Number |
Title | Effective Date |
|---|---|---|
|
45-2 |
Special open enrollment (SOE) | |
| 45-2A | Addendum: special open enrollment (SOE) matrix: summary of permitted election changes |
Reinstatement, tolling and continuation coverage
|
Number |
Title | Effective Date |
|---|---|---|
|
56-1 |
Reinstatement for subscribers with mental or physical impairment or incapacitation |
|
| 56-2 | Election period tolling for applicants with mental or physical impairment or incapacitation |
Appeals
|
Number |
Title | Effective Date |
|---|---|---|
| 60-1 | Required appeals related documents when the SEBB Program conducts a brief adjudicative proceeding |
Administrative - permanent
| Number | Title | Effective Date |
|---|---|---|
| 90-1 | Allowable mid-year termination for an employer group | 1/1/2025 |
| 90-2 | What authority do employer groups need before contracting with HCA for participation in SEBB for insurance coverage? | 1/1/2025 |
| 90-3 | Determining if an employer group requesting eligibility criteria different from SEBB Program rules shall be approved | 1/1/2025 |
| 90-4 | Terms and conditions set by HCA for an employer group and school employees of an employer group | 1/1/2025 |
| 91-1 | Requesting a reasonable alternative for completing wellness incentive program requirements or avoiding the tobacco use premium surcharge | |
| 91-2 | Tobacco as it relates to religious or ceremonial use | |
| 91-3 | Washington Wellness worksite designation program incentive requirements | |
| 93-2 |
SEBB Program payment plans |
|
| 94-1 | Accessing SEBB Program salary reduction plan document | |
| 94-2 | Accessing SEBB Program wellness plan document | |
| 94-3 | Subscriber mistake - Factor test |
Proposed policies
There are currently no proposed policies.
Rescinded policies
The polices listed below are rescinded.
|
Number |
Title |
Policy effective date |
|---|---|---|
| 11-3 | Correcting School Employees Benefits Board Organizations and contracted vendor enrollment errors | 1/1/2023 1/1/2022 |
| 12-1 | Determining the first day of school for SEBB organizations | 1/1/2022 |
|
19-1 |
Termination due to loss of eligibility |
1/1/2024 1/1/2023 1/1/2022 |
| 19-1A | Addendum: Termination due to loss of eligibility of enrollment error - School employee | 1/1/2024 1/1/2023 1/1/2022 |
| 19-1B | Addendum: Termination due to loss of eligibility for nonpayment - Self-pay subscriber | 1/1/2024 1/1/2023 1/1/2022 |
| 31-1 | Verifying dependent eligibility before enrollment | 1/1/2023 1/1/2022 |
| 31-2 | Use of premium surcharge help sheet and spousal plan calculator tools | 1/1/2024 1/1/2023 1/1/2022 |
| 36-1 | Certifying eligibility for a dependent child with a disability who is age 26 or older | 1/1/2024 1/1/2023 |
| 37-1 | Certifying eligibility for an extended dependent child | 1/1/2024 1/1/2023 1/1/2022 |
| 45-2 | Special Open Enrollment (SOE) | |
| 45-2A | Special open enrollment matrix: Summary of permitted election changes | 1/1/2024 1/1/2023 1/1/2022 |
| 56-1 | Continuation coverage reinstatement for subscribers with mental or physical impairment or incapacitation | 1/1/2024 1/1/2023 1/1/2022 |
| 56-2 | Election period tolling for applicants with mental or physical impairment or incapacitation | 1/1/2024 1/1/2023 1/1/2022 |
| 91-1 | Requesting a reasonable alternative for completing wellness incentive program requirements or avoiding the tobacco use premium surcharge | 1/1/2023 |
| 91-2 | Tobacco as it relates to religious or ceremonial use | 1/1/2023 1/1/2022 |
| 91-3 | Washington Wellness worksite designation program incentive requirements | 1/1/2024 1/1/2023 1/1/2022 |
| 93-2 | SEBB Program payment plans for continuation coverage amounts | 1/1/2023 |
| 94-1 | Accessing SEBB Program salary reduction plan document | 1/1/2023 |
| 94-2 | Accessing SEBB Program wellness plan document | 1/1/2023 |
| 94-3 | Subscriber mistake - Factor test | 1/1/2024 1/1/2023 |