Forms and publications
Access manuals, forms, enrollment guides, and other resources to support benefits administrators (BAs) with the administration of School Employees Benefits Board (SEBB) benefits.
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Below you will find manuals, user guides, and resources related to the Benefits 24/7 online enrollment system, accounting, correcting SEBB organization errors, appeals, and HCA Support. Employee enrollment resources, such as guides and forms, certification forms for dependents, and many other resources are also available to download.
When printing forms to share with employees, also provide the SEBB nondiscrimination statement and language access notice.
Benefits 24/7
- Benefits 24/7 manuals and resources
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The following resources are for benefits administrators (BAs).
- Benefits 24/7
- Benefits 24/7 manuals
- Eligibility file specifications
- Lower limit calendar (2024) (2025)
Learn more on the Administering SEBB in Benefits 24/7 webpage.
Accounting
- Accounting manuals and resources
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The accounting manual contains the current year's invoicing dates along with other accounting-related guidance.
- Accounting training manual (2024) (2025)
- SEBB Program monthly billing cycle
- Lower limit calendar (2024) (2025)
These resources can also be found on the Accounting webpage.
- Supplemental benefits billing resources
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Life and accidental death and dismemberment (AD&D) insurance
MetLife manages billing and processes enrollment and claims for SEBB life and accidental death and dismemberment insurance.
- Life and AD&D administration manual
- SEBB list bill process and guidelines
- SEBB paper list bill example
- SEBB bill record layout
- SEBB remit record layout
- Enrollment and supplemental billing guide for new employers joining SEBB
Long-term disability (LTD) insurance
The Standard manages billing and processes claims for SEBB long-term disability insurance (LTD).
- SEBB LTD Administration Manual
- LTD employer portal
- Portal authorization instructions
- LTD premium calculation
- Sample invoice
- Payment letter
Flexible Spending Arrangements (FSAs) and the Dependent Care Assistance Program (DCAP)
Navia manages billing and processes claims for the SEBB Program's Medical Flexible Spending Arrangement (FSA), Limited Purpose FSA, and the Dependent Care Assistance Program.
- Access the Navia Employer Portal
These resources can also be found on the Accounting webpage.
Correcting SEBB organization errors
- Error correction resources
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- SEBB Error Correction Guidelines
- Sample correction/recourse letters
Learn more on the Correcting SEBB organization errors webpage.
Appeals
- Appeals form and resources
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- SEBB Appeals process map
- Employee Request for Review/Notice of Appeal form
- Authorization for Release of Information
Learn more on the Appeals process webpage.
HCA Support
HCA Support is a secure, web-based correspondence program that allows you to send documents and communicate directly with O&T, SEBB Accounting, and other departments within the SEBB Program by using the ​​​​designated tile named, "Benefits administrator inquiry".
- HCA Support resources
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It's important that BAs use the designated tile named, "Benefits administrator inquiry". Using the "General Support" tile will lead to a delayed response, as your inquiry will be initially routed to units at HCA that are outside of O&T.
Employees and dependents
- Enrollment guide, forms, and resources
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Employees are encouraged to complete enrollment online using Benefits 24/7. However, the forms provided below can also be used for employee and dependent enrollment.
- School Employee Enrollment Guide (2024) (2025)
- The following school employee enrollment and change forms can be used by eligible employees of SEBB organizations:
- The following school employee enrollment/change form can be used by employees of SEBB employer groups who contract with the SEBB Program to offer medical-only benefits to their eligible employees:
- LTD Enrollment/Change form
Employees may use the following forms to complete their enrollment in supplemental life and supplemental accidental death and dismemberment (AD&D) insurance and to elect participation in a flexible spending arrangement (FSA) or the Dependent Care Assistance Program (DCAP). Enrollment in these benefits cannot be completed using Benefits 24/7.
- MetLife Enrollment/Change form (for electing supplemental life and AD&D insurance and adding beneficiaries)
- MetLife Beneficiary Designation form (for adding or updating beneficiaries only)
- FSA and DCAP Midyear Enrollment form
Learn more on the Employee enrollment webpage.
- Dependent forms and resources
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- Certification of a Child with a Disability form
- Extended Dependent Certification form
- Declaration of Tax Status form (2024) (2025)
- SEBB Policy 31-1: Verifying dependent eligibility before enrollment
- SEBB Policy 33-1: Additional verification requirements for partners of a legal union
- SEBB Policy 36-1: Certifying eligibility for a dependent child with a disability who is age 26 or older (2024) (2025)
- SEBB Policy 37-1: Certifying eligibility for an extended dependent child (2024) (2025)
Learn more on the Dependents webpage.
- Premium surcharges
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- Premium Surcharge Attestation Change form (2024) (2025)
- Spousal Plan Calculator (print version) (2024) (2025)
- Spousal Plan Calculator (interactive tool) (2024) (2025)
Learn more on the Premium surcharges webpage.
Life and accidental death and dismemberment (AD&D) insurance
- Life and AD&D forms and resources
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- Life and AD&D Administration Manual
- Certificate of Coverage (COC) (at least 630 hours)
- Certificate of Coverage (COC) (less than 630 hours)
- MetLife Advantages
- Employees can use MetLife's MyBenefits portal to add/update beneficiaries and elect/change supplemental coverages or they can use the forms provided below.
- Notification of enrollment extension form for supplemental life
- Privacy notice
Learn more on the Life and AD&D webpage.
Long-term disability (LTD) insurance
- LTD forms and resources
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- LTD Administration Manual
- LTD plan booklet
- Enrollment/Change form
- Evidence of Insurability
- Claim packet
- LTD error or discrepancy correction form
Learn more on the LTD webpage.
Flexible Spending Arrangements (FSAs) and Dependent Care Assistance Program (DCAP)
- FSA and DCAP forms and resources
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- Midyear Enrollment form (2024) (2025)
- FSA and DCAP Claim form (2024) (2025)
- Change in Status form (2024) (2025)
- School Employment Transfer form
- FSA Termination form
- Find additional forms and documents on Navia's website.
Learn more on the FSA and DCAP webpage.
Additional forms and resources
- Apple Health (Medicaid)
- Dual enrollment
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Learn more on the Employee enrollment webpage
- Health Savings Account (HSA)
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- Employee Authorization for Payroll Deduction for HSA (2024) (2025)
- Beneficiary Designation
- Find additional HSA forms and documents on HealthEquity's website.
- Premium payments
SEBB Continuation Coverage
- COBRA and Unpaid Leave resources
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- Initial notice of COBRA and Continuation Coverage rights (2024) (2025)
- Continuation Coverage Election Notice (2024) (2025)
Learn more on the COBRA and Unpaid Leave webpages.
PEBB retiree insurance
- PEBB retiree insurance resources
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- Retiree Enrollment Guide (2024) (2025)
- PEBB retiree health insurance checklist
Learn more on the Retirees website.