Dependents

Worksheets for determining dependent eligibility for SEBB benefits

When employees express an interest in adding an eligible dependent to their SEBB medical, vision, and/or dental coverage, provide them with the E-1 worksheet. If an employee is seeking to add an extended dependent or dependent child with a disability age 26 or older, provide the E-2 worksheet.

The informational worksheets contain:

• A list of dependents who are eligible for SEBB benefits,
• A list of valid dependent verification (DV) documents,
• The process to add dependents to SEBB coverage for employees, and
• Guidance for processing DV for benefits administrators (BAs).

Encourage employees to review the worksheet and explain that dependents will not be enrolled in coverage unless all enrollment, verification, and certification requirements, if applicable, have been met within the required timeframe.

Who are eligible dependents?

Legal spouse

Former spouses are not eligible upon finalization of a divorce or annulment, even if a court order requires the employee to provide health insurance for the former spouse.

Extended dependent children

Children in legal custody or legal guardianship of the employee or the employee's spouse/SRDP.

• Certification is required by the SEBB Program.
• This does not include foster children unless the employee or the employee's spouse/SRDP has assumed legal obligation for total or partial support in anticipation of adoption.

Dependent children with a disability age 26 and older

Children, age 26 and older, with a developmental or physical disability that renders the child incapable of self-sustaining employment and is chiefly dependent on the employee for support and maintenance.

• The disability must occur prior to age 26.
• If the child is enrolled prior to turning 26, the employee must provide proof of the disability and dependency within 60 days of the child's attainment of age 26.
• Certification is required by the SEBB Program (with input from the employee’s medical plan, if applicable).
• Children specified in a court order or divorce decree for whom the employee has a legal obligation to provide support or health coverage.

Children through the last day of the month of their 26^th birthday

Children based on establishment of a parent-child relationship as described in RCW 26.26A.100, unless parental rights have been terminated. Stepchildren: Children of the employee’s spouse/SRDP who are not legally adopted by the employee.

• A stepchild’s eligibility as a dependent ends on the same date the marriage or partnership ends through divorce, annulment, dissolution, termination, or death.

Children for whom the employee has assumed legal obligation for total or partial support in anticipation of adoption.

State-registered domestic partner (SRDP)

This includes substantially equivalent legal unions from another state or jurisdiction (e.g., Out-of-state registered domestic partnerships, city or county domestic partnerships within the state of Washington, etc.) (RCW 26.60.090 and 26.04.260).

• The SEBB Program must review and determine if the union meets the criteria listed in SEBB Policy 33-1.

Former SRDPs are not eligible upon dissolution or termination of a partnership, even if a court order requires the employee to provide health insurance for the former partner.

The SEBB Program reserves the right to review eligibility at any time (SEBB Policy 31-1 and WAC 182-31-140).

Requirements to enroll eligible dependents

Medical, vision, and dental coverage

To enroll eligible dependents in SEBB medical, vision, and/or dental coverage, employees must:

• Enter the required information for their dependents in Benefits 24/7, or complete the appropriate School Employee Enrollment form,
• Provide valid dependent verification (DV) documents, and
• Submit any additional required forms (if applicable).

All required forms and documents must be received no later than (WAC 182-31-150):

• 31 days after the employee becomes eligible for SEBB benefits.
  • The employee’s eligibility information must be entered into Benefits 24/7 before the employee can add their dependents and elect coverage.
  • If approved, dependent coverage begins on the same day as the employee's effective date of coverage.
• The last day of annual open enrollment.
  • If approved, dependent coverage begins on January 1 of the following year.
• 60 days after a qualifying special open enrollment event occurs.
  • Generally, if approved, dependent coverage will begin the first of the month following the event date or the date the required form is received, whichever is later. If that day is the first of the month, the change in enrollment begins on that day.
  • Proof of the qualifying event must be provided. Learn more about special open enrollment events.

Life and accidental death and dismemberment (AD&D) insurance

To enroll eligible dependents in supplemental life and/or AD&D insurance employees must use the MetLife MyBenefits portal or complete and submit the MetLife Enrollment/Change form directly to MetLife using the submission instructions provided on the form.

Generally, coverage will be effective the first day of the month following the date MetLife receives the required form or approves the enrollment.

Learn more about Life and AD&D insurance.

Why is dependent verification required?

The SEBB Program requires that employees provide documentation that verifies the relationship between the employee and their dependent(s) before they can be enrolled in an employee's SEBB medical, vision, and/or dental coverage (WAC 182-31-140).

Exception: If an employee moves from Public Employees Benefits Board (PEBB) Program coverage to SEBB coverage, previous dependent verification data may be used if the employee is requesting to enroll an eligible dependent who was verified under the PEBB Program. Send a message to Outreach and Training through HCA Support to request a review of dependents who may have been previously verified.

What are valid dependent verification documents?

Birth certificates, adoption decrees, tax returns, and parenting plans are among the types of documents that can be used to verify a dependent's eligibility. In some cases, additional forms and documentation may be required.

Review the information below for a list of valid dependent verification documents that can be used to verify a dependent as well as any additional forms or documents that may be required.

To verify a spouse

Employees adding a spouse to their coverage must provide a copy of one of the following:

• Most recent year's federal tax return (black out financial information), either:
  • A single return that lists their spouse if filed jointly.
  • Each return for the employee and spouse, if filed separately.
• Marriage certificate and proof that the marriage is still valid (the employee and spouse do not have to live together), such as a utility bill, life insurance beneficiary document, or bank statement, within the last six months showing both the employee and spouse's name (black out financial information).
  • If the spouse is being added within six months of marriage, only the certificate is required.
• A recently filed (within the last six months) petition for dissolution/invalidity of marriage, or legal separation notice.
• Defense Enrollment Eligibility Reporting System (DEERS) registration
• Valid J-1 or J-2 visa issued by the U.S. Government

To verify a state-registered domestic partner or partner of a legal union

Employees adding a state-registered domestic partner or partner of a legal union to their coverage must submit one of the following during the require timeframe:

• Certificate/card of a state-registered domestic partnership or a legal union and proof the partnership is still valid (the employee and partner do not have to live together), such as a utility bill, life insurance beneficiary document, or bank statement dated within the last six months showing both the employee and partner's name (black out any financial information).
  • If the partner is being added within six months of state registration, only the card is required.
• A recently filed (within the last six months) petition for dissolution or petition to invalidate state-registered domestic partnership.

Adding a partner of a legal union

This includes substantially equivalent legal unions from another state or jurisdiction (e.g., Out-of-state registered domestic partnerships, city or county domestic partnerships within the state of Washington, etc.) (RCW 26.60.090 and 26.04.260).

If adding a partner of a legal union, the employee must also provide:

• Proof of Washington State residency for both the employee and partner.
  • The SEBB Program must review and determine if the union meets the criteria listed in SEBB Policy 33-1. Documents used to verify a partner of a legal union should not be uploaded in Benefits 24/7. Instead, submit these documents to the SEBB Program through HCA Support.
  • Additional dependent verification documents will be required within one year of the partner's enrollment for them to remain enrolled.

More information can be found in SEBB Policy 31-1 and 33-1.

Declaration of tax status

Employees adding a state-registered domestic partner or partner of a legal union to their coverage must also submit the Declaration of Tax Status form to their benefits administrator within the required timeframe to indicate whether their dependent qualifies for tax purposes under IRC Section 152, as modified by IRC Section 105(b).

The Declaration of Tax Status form is processed by the employer and should not be sent to the SEBB Program or uploaded in Benefits 24/7.

To verify a child

Employees adding a child to their coverage, must provide a copy of one of the following:

• The most recent year's federal tax return that includes the child as a dependent (black out financial information).
  • Employees can submit one copy of their tax return if it includes all family members that require verification.
• Birth certificate (or hospital certificate with the child's footprints on it) showing the name of the parent who is the employee or the employee's spouse or state-registered domestic partner (SRDP).
• Certificate or decree of adoption showing the name of the parent who is the employee or the employee's spouse or SRDP.
• Court-ordered parenting plan
• National Medical Support Notice
• Defense Enrollment Eligibility Reporting System (DEERS) registration
• Valid J-2 visa issued by the U.S. Government

Adding a stepchild

If the dependent is the employee's stepchild, The employee must also verify the spouse or SRDP in order to enroll the stepchild, even if not enrolling the spouse or SRDP in SEBB insurance coverage.

If the employee is adding their stepchild, who is a child of a state-registered domestic partner or partner of a legal union to their coverage, they must also submit the Declaration of Tax Status form to their benefits administrator within the required timeframes to indicate whether their dependent qualifies for tax purposes under IRC Section 152, as modified by IRC Section 105(b).

The Declaration of Tax Status form is processed by the employer and should not be sent to the SEBB Program or uploaded in Benefits 24/7.

To certify a dependent child with a disability age 26 or older

Employees adding a dependent child with a disability, age 26 or older, to their coverage must submit the following during the require timeframe:

• Valid dependent verification documents to enroll a child, and
• Certification of a Child with a Disability form.

The dependent verification documents should be uploaded to the employee’s account in Benefits 24/7. for verification. The employee should submit the Certification of a Child with a Disability form to either the SEBB Program or the medical carrier, using the submission instructions provided on the form. The form should not be submitted by the employer through HCA Support.

Moving from the PEBB Program to the SEBB Program

If the employee moves from Public Employees Benefits Board (PEBB) Program coverage to SEBB Program coverage with a disabled dependent and the disabled dependent is currently enrolled in health plan coverage through the PEBB Program, they are not required to complete the SEBB Certification of a Child with a Disability form to recertify until their current certification issued, while they were enrolled in PEBB health plan coverage, expires.

Additional information can be found in the E-2 worksheet and SEBB Policy 36-1.

To certify an extended dependent child

Employees adding an extended dependent child to their coverage must submit the following during the required timeframe:

• Extended Dependent Certification form,
• Declaration of Tax Status form, and
• A copy of a valid court order showing legal custody or guardianship. The court order serves as dependent verification for extended dependents.

The employee must submit the forms and documents to their benefits administrator. The Declaration of Tax Status form is processed by the employer and should not be sent to the SEBB Program or uploaded in Benefits 24/7. Learn about reporting the tax status of a dependent.

Learn how the Extended Dependent Certification form is processed in the next section.

Moving from the PEBB Program to the SEBB Program

If the employee moves from Public Employees Benefits Board (PEBB) Program coverage to SEBB Program coverage with an extended dependent, and the extended dependent is currently enrolled in health plan coverage through the PEBB Program, they are not required to recertify until the current certification issued, while the employee is enrolled in PEBB Program coverage, expires.

Additional information can be found in the E-2 worksheet and SEBB Policy 37-1.

All dependent verification documents must be submitted in English. Any documents written in a foreign language must include a translated copy prepared by a professional translator and certified with a notary public seal.

How do BAs process dependent verification?

Once the required forms and dependent verification (DV) have been received, verify that:

• All forms and DV have been received within the required timeframe, and
• All forms are completed correctly, and
• All enrollments or changes requested are allowed, and
• The DV is valid, legible, and complete.
  • If the DV documents are not valid, legible, or complete, follow-up with the employee to request they submit valid DV within the required timeframe.

If the forms and documents meet the criteria above, complete the steps provided in Chapter 3 of the Benefits 24/7 manual to verify the dependent(s).
Note: Verifying dependents requires Benefits24/7 Admin or Edit access.

How are additional forms processed?

Certification of a Child with a Disability form

The employee must submit the Certification of a Child with a Disability form to either the SEBB Program or the medical carrier for review, using the submission instructions provided on the form. The form should not be sent by the employer through HCA Support or uploaded in Benefits 24/7.

Once the form has been received and reviewed, the SEBB Program will notify the employee and the SEBB Organization of the approval or denial.

Approval

A medical review will be conducted to determine if the dependent meets the medical requirements of a dependent child with a disability. If the employee changes health plans, the new health plan will conduct a medical review to continue the dependent's certification.

Denial

Dependents who fail the medical review may appeal to the entity that made the determination. If the denial is due to recertification, the SEBB Program will send a SEBB Continuation Coverage Election Notice.

Recertification

The SEBB Program will periodically verify the eligibility of a dependent child age 26 or older with a disability, but no more frequently than annually after the two-year period following the child’s 26th birthday. Verification will require renewed proof of disability and dependence from the subscriber. The initial verification and any following verification will be conducted according to WAC 182-31-140 (3)(f)(i) through (v).

Additional information can be found in the E-2 worksheet and SEBB Policy 36-1.

Extended Dependent Certification form

Employees adding an extended dependent child to their coverage must upload the Extended Dependent Certification form and copy of a valid court order in Benefits 24/7 or submit the documents to their benefits administrator to upload into Benefits 24/7 on the employee’s behalf.

The SEBB Program will review the Extended Dependent Certification form and court order and notify the employee and the SEBB Organization of the approval or denial.

Approval

If the dependent meets the eligibility requirements, the SEBB Program will notify the employee and SEBB Organization in writing. The copy of the approval letter sent to the employer should be placed in the employee's file.

Denial

If the dependent does not meet eligibility requirements, the SEBB Program will notify the employee and SEBB Organization in writing. A copy of the denial letter sent to the employer should be placed in the employee's file. If the denial is due to recertification, the SEBB Program will also send a SEBB Continuation Coverage Election Notice to the dependent.

Recertification

Eligibility will be recertified annually. However, the SEBB Program reserves the right to review an extended dependent child's eligibility at any time. When recertification is required, the employee will receive a letter from SEBB with instructions to submit all recertification information directly to the SEBB Program.

Additional information can be found in the E-2 worksheet and SEBB Policy 37-1.

Declaration of Tax Status form

Employees requesting to enroll any of the following types of dependents must submit the Declaration of Tax Status form to their benefits administrator within the required timeframes to indicate whether their dependent qualifies for tax purposes under IRC Section 152, as modified by IRC Section 105(b):

• Extended dependent children
• State-registered domestic partner or partner of a legal union
• Children of a state-registered domestic partner or partner of a legal union

The Declaration of Tax Status form is processed by the employer and should not be sent to the SEBB Program or uploaded in Benefits 24/7. Learn about reporting the tax status of a dependent.

What if the required forms and DV are not received timely?

If the required forms and/or valid DV documents are not received within the required timeframe, inform the employee that their dependents will not be enrolled and inform them of their right to appeal.

The employee may enroll their dependents during the next annual open enrollment period or if they have a qualifying life event that triggers a special open enrollment.

Adding a newborn or adopted child

The birth or adoption of a child creates a special open enrollment.

To add a newborn or child whom the employee has adopted or has assumed a legal obligation for total or partial support in anticipation of adoption, the employee must submit required forms and dependent verification (DV) within the following timeframes:

• If adding the child increases the employee’s monthly medical premium, the required forms and DV must be received no later than 60 days after the date of the birth, adoption, or the date the legal obligation is assumed for total or partial support in anticipation of adoption.
• If adding the child does not increase the employee premium, required forms and DV must be received as soon as possible to ensure timely payment of claims.

When is coverage effective for a newborn or adopted child?

Newborn children may be enrolled in medical, vision, and dental coverage upon birth and adopted children may be enrolled when the employee assumes legal obligation for total or partial support in anticipation of adoption.

• If enrolling a newborn in medical and/or dental coverage, the child's coverage will begin on the date of birth.
• If enrolling a newborn in supplemental life or AD&D insurance, the child must be at least 14 days old before supplemental life and A&D coverage can become effective.
• If enrolling a newly adopted child, coverage will begin on the date of placement or the date a legal obligation is assumed in anticipation of adoption, whichever is earlier.

If the employee previously waived medical coverage, they must enroll in medical to add an eligible dependent to medical. Coverage for the employee begins on the first day of the month in which the event occurs.

When a newborn or adopted child's effective date is before the 16th day of the month, the employee will pay the full month's employee premium. Otherwise, the new premium will begin the next full calendar month.

Learn more about what changes can be made due to birth or adoption by reviewing the SOE Matrix - SEBB Policy 45-2A.

When dependent eligibility for SEBB benefits ends

A dependent's eligibility for enrollment in SEBB medical, vision, dental, and supplemental dependent life and AD&D insurance ends the last day of the month the dependent meets the eligibility criteria listed in WAC 182-31-140.

Dependents who are no longer eligible must be removed from SEBB coverage.

Employees must remove the dependent from their account in Benefits 24/7 or submit the appropriate completed School Employee Change form to their benefits administrator within 60 days of the last day of the month the dependent lost eligibility for SEBB benefits. If a dependent child with a disability age 26 or older is no longer eligible, written notice must be provided to the SEBB Program.

Dependent coverage ends on the last day of the month in which they no longer meet the eligibility criteria for SEBB benefits.