Correcting SEBB organization errors

Enrollment errors

The types of errors which require correction are as follows:

• Failure to timely notify an employee of their eligibility for SEBB benefits and the organization contribution (WAC 182-31-030 (2)).
• Failure to enroll an employee, or their dependents, as elected by the employee, if the election was timely.
• Failure to accurately reflect an employee's premium surcharge attestation on the employee's account.
• Providing incorrect information regarding SEBB benefits to an employee which the employee relied upon.
• Failure to enroll an employee in default enrollment when the elections were not received timely (WAC 182-30-080 (1)(b)).
• Enrolling an employee or their dependent in SEBB benefits when they were not eligible, and it is clear there was no fraud or intentional misrepresentation by the employee involved (WAC 182-31-040 or 182-31-140).

How do organizations correct enrollment errors?

The process to correct SEBB organization errors depends on whether or not the effective date of the correction falls within the lower limit.

Correcting errors within the lower limit

In most cases, an enrollment error may be resolved by the SEBB Organization in accordance with SEBB Program rules and policies, if the effective date of the correction falls within the lower limit. In other words, the error may be resolved directly by the organization if Benefits 24/7 will allow you to enter the enrollment correction.

Employees should be notified of any corrections that impact the employee or their dependent’s enrollment.

If the effective date of the correction falls outside the lower limit, the organization must complete the error correction process.

Enrollments

When correcting an organization error that results in the employee or dependent being enrolled in SEBB benefits, enter the eligibility date in Benefits 24/7 that would have been entered had the enrollment been processed timely.

If Benefits 24/7 does not allow you to make the correction within the lower limit, contact Outreach and Training (O&T) through HCA Support.

Terminations

When correcting an organization error that results in the termination of SEBB benefits, the effective date will depend on whether it’s the employee’s or dependent’s coverage being terminated and the reason for the termination.

Review SEBB Policy 19-1A to identify the effective date of a correction that results in the termination of SEBB benefits.

If Benefits 24/7 does not allow you to make the correction within the lower limit, contact O&T through HCA Support.

Correcting errors outside the lower limit (error correction)

When the effective date of the correction falls outside the lower limit, the organization must follow the steps below to complete the error correction process.

1. Draft a correction/recourse notice. The notice must be approved by the SEBB Program (SEBB) prior to being sent to the employee.
   The notice must describe the error that occurred, how it will be corrected, and the recourse options available to the employee.
   • Sample correction/recourse notices:
     • Failure to enroll accurately
     • Failure to enroll in default coverage
     • Failure to timely notify newly eligible employee
   • Recourse options available to the employee are (WAC 182-30-060(5)):
     • Retroactive enrollment in a SEBB medical, vision, and/or dental plan.
     • Reimbursement of claims paid.
     • Reimbursement of amounts paid by the employee or dependent for medical, vision, and dental premiums.
     • Reimbursement of amounts paid by the employee for the premium surcharges.
     • Other legal remedy received or offered.
     • Other recourse, upon SEBB approval.
2. Send the draft notice to Outreach and Training (O&T) through HCA Support for SEBB review.
3. If the notice is approved by SEBB, send the notice to the employee.
   • • The notice will allow the employee to request their own recourse.
     • The employee will have 31 days to review, complete, sign, and return the notice and all required documents to their organization.
       • If the employee fails to return the notice and required documents, this must be reported using the same HCA Support case number used to submit the initial notice draft for review.
       • If the employee disagrees with a recourse decision of the organization or SEBB Program, they may appeal the decision by submitting an appeal within 30 days.
4. Once received, send the completed and signed copy of the notice and any required documents to O&T using the same HCA Support case number.
5. The correction will be noted by SEBB and enrollment will be completed in the Benefits 24/7 by:
   • O&T if the correction is retroactive, or
   • The organization, at the direction of O&T, if the correction is prospective.

Reconciling premium payments and premium surcharges

In addition to following the necessary steps to correct errors, organizations must also reconcile related premium payments and applicable premium surcharges as described below (WAC 182-30-060).

• The organization must remit to the Health Care Authority (HCA) the employer contribution and the employee contribution for the medical plan premium, applicable premium surcharges, basic life, basic accidental death and dismemberment, and employer-paid long-term disability (LTD) starting the date SEBB benefits begin.
  • If an organization fails to notify a newly eligible employee of their eligibility for SEBB benefits, the organization may only collect the employee contribution for health plan premiums and applicable premium surcharges for coverage for the months after the employee was notified.
  • If the organization fails to correctly enroll the amount of employee-paid LTD insurance elected by the employee, premiums will be corrected as follows:
    • If additional premiums are due to the HCA, the employee is responsible for premiums for the most recent 24 months of coverage. The organization is responsible for additional months of premiums.
    • If a premium refund is due to the employee, the LTD insurance contracted vendor (The Standard) is responsible for premium refunds for the most recent 24months of coverage. The organization is responsible for additional months of premium refunds after the 24 months of coverage and the overall refunding process to the employee.
  • If the organization mistakenly enrolls an employee or their dependents when they are not eligible and it was clear there was no fraud or intentional misrepresentation by the employee involved, premiums and any applicable premium surcharges will be refunded by the organization to the employee without rescinding the insurance coverage.

Learn about reconciling your account in the SEBB Accounting Manual.

Related rules and policies

• WAC 182-30-020 Definitions
• WAC 182-30-060 How do SEBB organizations and contracted vendors correct enrollment errors?
• SEBB Policy 11-3: Correcting SEBB Organization and contracted vendor enrollment errors
• SEBB Policy Addended 19-1A: Termination due to loss of eligibility or enrollment error