The formula for insuring SEBB organization employees and their dependents includes an estimated rate of employee waivers. If anticipated waivers weren’t factored in, that uncertainty would need to be funded by raising the amount employers pay  per employee for benefits. The state pools funds to pay for everyone enrolled in the program. Also, keep in mind that employees who waive medical will still receive other benefits.

Yes. Dependents must be enrolled in the same health plans as the subscriber. This applies whether the subscriber is enrolled in medical or waives it.

All eligible school employees must be enrolled in SEBB benefits.

An eligible employee can waive SEBB medical coverage when newly eligible or during the SEBB Program’s annual open enrollment if they are enrolled in other employer-based group medical insurance, a TRICARE plan, or Medicare.

Eligible employees who waive enrollment in medical must enroll in SEBB dental, vision, basic life and AD&D insurance, and employer-paid long-term disability insurance for themselves. However, dual enrollment prohibition rules do allow an employee to waive SEBB medical, vision, and dental to enroll in Public Employees Benefits Board (PEBB) medical (with vision) and dental (WAC 182-31-080). 

If an employee waives SEBB medical coverage:

• They cannot enroll their eligible dependents in SEBB medical coverage.
• The premium surcharges will not apply to them.
• They will be able to access SmartHealth, the online health and wellness portal but they will not be able to earn the incentives. Their spouse or state-registered domestic partner will not have SmartHealth access.
• They can reenroll later during the annual open enrollment or if they have a qualifying special open enrollment event.

Reminder that eligible employees do not pay a premium for dental or vision coverage.

No. Medicare is not employer-based group medical coverage, so the premium surcharge does not apply.

Yes. The primary coverage would be through the SEBB Program on any claims the spouse or state-registered domestic partner might have. Medicare would be the secondary payer, and only pays if the SEBB plan pays less than Medicare would have paid.

If employees do not choose medical, dental, and vision plans, they will be automatically enrolled in UMP Achieve 1 (medical), Uniform Dental Plan (dental) and MetLife (vision). These plans are available in all Washington counties.

No. SEBB coverage is limited to a single enrollment per individual. If an employee and their spouse or state-registered domestic partner both enroll in the SEBB Program, they must decide which account to use to cover their children.

Employers will continue to pay the full employer contribution for employees who go on approved leave without pay if they have already worked 630 hours during the school year or if they are on approved FMLA.

If the school employee has not worked 630 hours and the employer no longer anticipates the school employee will work 630 hours during the school year, the school employee is no longer eligible for the employer contribution toward SEBB benefits.

When the school employee returns to work after their unpaid leave, the employer will determine whether the employee is eligible for the employer contribution toward SEBB benefits. Employees who return from approved leave without pay will establish eligibility for the employer contribution if their work schedule, had it been in effect at the start of the school year, would have resulted in the employee being anticipated to work the minimum hours to meet SEBB eligibility in the school year.

The Health Care Authority (HCA) administers the continuation coverage for COBRA and unpaid leave starting January 1, 2020. At that time, once a SEBB organization notifies the SEBB Program through Benefits 24/7 that a school employee has lost eligibility for SEBB benefits, HCA will mail a SEBB Continuation Coverage Election Notice booklet to the subscriber and/or any enrolled dependent who lost SEBB coverage. The subscriber and/or dependents will work directly with HCA to enroll in and pay for benefits under SEBB Continuation Coverage. They cannot enroll in continuation coverage through Benefits 24/7. A paper enrollment form will be included in the SEBB Continuation Coverage Election Notice. See the SEBB Continuation Coverage webpage for more information.

Benefit administrators can view dependent verification requests from the Benefits 24/7 dashboard or through a downloadable report.