School Employees Benefits Board (SEBB) Program FAQs

Staff at the Health Care Authority (HCA) are honored to be building the School Employee Benefit Board (SEBB) Program for school employees across the state. We want to answer your questions and supply you with as much information as possible. However, it is still early in the process, and many questions cannot be answered at this time. As the Board makes decisions and work progresses, we will update answers, add new questions, and provide more information. Please check back for updates from time to time. Last update: November 15, 2018.

General

When will the SEBB Program begin offering benefits to school employees?

Under EHB 2242, benefits will be available starting January 1, 2020.

I am currently enrolled in a Public Employees Benefits Board (PEBB) health plan. What does the creation of the SEBB Program mean for me?

You will continue to receive benefits from the PEBB Program through December 31, 2019. Beginning January 1, 2020, all school employees will receive benefits under the SEBB Program.

The SEBB program does not affect K-12 retirees, unless the Legislature decides to change this. All K-12 retirees will continue to receive benefits through the PEBB Program.

What is the difference between the insurance plan year and the school year?

The insurance plan year for SEBB is a calendar year, January 1 through December 31. The school year, as defined in RCW 28A.150.203(11), is September 1 through August 31. Your benefit eligibility and coverage period are based on the school year.

What’s the difference between “fully insured” and “self-insured” plans?

Basically, a “fully insured” plan is offered by commercial carriers, which choose what is covered (this is called the “benefit design”). Not all fully insured plans are offered in all counties.

A “self-insured” plan is offered by the employer organization — in this case, Washington State. The state develops the benefit design and has more control over plan costs. Our self-insured plan is called the Uniform Medical Plan (UMP), administered by Regence. UMP will be available to all SEBB subscribers.

SEBB will offer several health care options, both fully insured and self-insured plans, with differing benefits and plan costs. Details will be available in time for open enrollment in the fall.

Eligibility

Who will be eligible for benefits from the SEBB Program?

School employees who are anticipated to work at least 630 hours during the school year are eligible.

Will my dependents be covered?

Spouses and state-registered domestic partners, children up to age 26, children with disabilities, and extended dependents are eligible. Learn more about dependents.

When do new employees start receiving benefits?

It depends on when they are hired.

New school employees: In September each year, new school employees who are anticipated to work 630 hours during the school year and whose first day of work is September 1 through the first day of school are eligible for the SEBB Program. They will start coverage on their first day of work.

Returning school employees: For school employees anticipated to work 630 hours during the school year and whose first day of work is at any other time during the school year, the effective date of coverage is the first day of the month following the day they begin work.

School employees hired late in the school year: School employees hired late in the school year but anticipated to work 630 hours or more the following year fall into two categories.

  • Employees hired on a nine- to 10-month basis will be eligible for SEBB benefits on their first day of work if they are anticipated to be compensated for at least 17.5 compensated hours a week in six of the last eight weeks counting backward from the week that contains the last day of school. Their benefits would begin the first of the month after they begin work.
  • Employees hired on a 12-month basis will be eligible for SEBB benefits on their first day of work if they are anticipated to be compensated for at least 17.5 compensated hours a week in six of the last eight weeks counting backward from the week that contains August 31, the last day of the school year.  Their benefits would begin the first of the month after they begin work.

What if, at the beginning of the school year, I am not anticipated to work 630 hours, but later my schedule changes, and then I am anticipated to work 630 hours?

The employee becomes eligible on the day they are notified of the schedule change. Their coverage begins on the first day of the following month.

For example, a substitute bus driver is not eligible for SEBB benefits in September because they are anticipated to work fewer than 630 hours during the school year. But in October their work schedule changes and they are then anticipated to work more than 630 hours during the school year. They become eligible the day they are notified of the change, and their coverage begins November 1.

What happens if an employee is not anticipated to reach 630 hours during the school year, but subsequently does reach 630 hours?

The employee becomes eligible on the day they reach 630 hours. Their coverage begins on the first day of the following month.

For example, a substitute teacher who is not anticipated to work 630 hours at the beginning of the school year is not eligible for the SEBB Program. However, there is more work for them than expected, and in February they reach 630 hours. They become eligible on that day. Their coverage begins March 1.

What happens when an employee hits 630 hours but is not anticipated to hit 630 hours the following year?

The employee would receive benefits in the school year they become eligible. Anticipated hours would be reassessed in September for the new school year. If they reach 630 hours two years in a row and return to the same type of position, they will be presumed eligible for the third year.

I work more than 630 hours during the school year. I expect to continue working in the same position next year. What happens to my benefits after August 31?

Your coverage will continue uninterrupted on September 1.

I’m a coach and am eligible for benefits. Am I covered past my sport’s season? What about next year?

If you are anticipated to work 630 hours during the school year you are eligible, and you are covered all through the school year. If you are anticipated to work 630 hours or more during the next school year, your coverage will continue without interruption.

Will I be able to waive SEBB insurance coverage?

Information about waiving benefits will be addressed by the Board.

How do the SEBB Program’s eligibility rules for state-registered domestic partners differ from the domestic partner eligibility currently offered by some school districts?

Some school districts currently offer an expanded domestic partner eligibility in which employees and their significant others can sign and file a declaration (or affidavit) with their employer or benefits administrator to receive benefits. Starting in 2020, SEBB Program eligibility rules will allow only state-registered domestic partners (as defined in RCW 26.60.020) to enroll as dependents.

Why is domestic partner eligibility limited to only state-registered domestic partners?

By law, the SEB Board establishes eligibility criteria for dependents, including legal spouses and state-registered domestic partners. To inform their decision, the SEB Board reviewed the specific reference to state-registered domestic partners in RCW 41.05.740(6)(d)(iii).

What happens if I move to another job?

You will have uninterrupted coverage when moving from one school district, ESD, or charter school to another within the same month or a consecutive month, if the following conditions are satisfied:

  • You were eligible for the employer contribution toward SEBB benefits in the position you are leaving; and
  • You are anticipated to be eligible for the employer contribution toward SEBB benefits in your new position.

Who will be responsible for verifying family members’ eligibility for coverage under the SEBB Program?

Employees are required to provide evidence of a dependent’s eligibility within the HCA’s timeframe. School personnel staff will verify family members’ eligibility for coverage. HCA staff will work with school personnel staff on how to do this.

Will existing employee dependents be grandfathered?

No. Employees’ dependents will not automatically be enrolled in SEBB. Employees must enroll their eligible family members to have them covered.

Enrollment

When will I be able to select the benefits I want?

Open enrollment for SEBB Program subscribers will take place October 1—November 15, 2019. Information about benefit options will be shared well in advance.

I am a new teacher, and I start work in August. When does my coverage start?

Your coverage starts on the first of the next month after you begin work. If you start work during August, your coverage would begin September 1.

I’m a new school employee and I start on September 3. School starts September 7. When does my coverage start?

Because you started between September 1 and the first day of school, your coverage begins on your first day of work, September 3.

I’m a new school employee and I will start work on the first day of school. When will my coverage start?

Because you started between September 1 and the first day of school, your coverage begins on your first day of work.

I’m a new bus driver. School starts on September 9, but I start work on September 12. When will my coverage start?

Your coverage begins the first day of the next month, October 1.

I want to get health coverage for my family. What do I do?

You can add eligible dependents to your coverage during open enrollment or during special open enrollment periods. See which dependents are eligible. You will have to provide evidence of your dependents’ eligibility within the SEBB Program’s enrollment timeframe. A list of acceptable documents and the enrollment deadlines will be available before open enrollment in fall 2019.

What is “dual enrollment?”

If you and your spouse or state-registered domestic partner are both eligible for SEBB benefits, you can't enroll on each other's accounts. We call that "dual enrollment," and it is not allowed in the SEBB Program. You need to decide which of you will cover yourselves and any eligible dependents on your medical or dental plans. You could waive medical coverage for yourself and enroll as a dependent on your spouse’s, state-registered domestic partner’s, or parent’s medical coverage. However, you must enroll in dental, basic life and AD&D, and basic long-term disability insurance under your own account.

Why is dual enrollment not allowed under the SEBB Program?

The single-enrollment policy helps maintain the affordability of the SEBB Program’s health plans. Allowing dual enrollment would increase the cost of the SEBB Program and could result in reduced benefits or higher costs in the future.

SEBB Program benefits

* New or updated November 15, 2018

What types of benefits will the SEBB Program offer? *

The SEBB Program will offer medical, dental, vision, life, accidental death and dismemberment, and long-term disability insurance, beginning January 1, 2020.

The SEB Board has authority to offer benefits that are not paid by the employer, such as the Medical Flexible Spending Arrangement, Dependent Care Assistance Program, and auto and home insurance.

How many medical and dental plans will the SEBB Program offer?

The number of plans the SEBB Program will offer depends on insurance carrier responses to procurements, and the types of plans and the benefit design selected by the SEB Board.

What dental benefits will be included? *

Yes. Eligible school employees can choose from up to three dental plan options, depending on where you live:

  • Delta Dental  (DeltaCare)
  • Uniform Dental Plan
  • Willamette Dental

Details of deductibles, out-of-pocket maximums, coverage, premiums, and other specifics will be available in time for open enrollment in fall 2019.

Will more than one vision plan be available? *

Yes. All eligible employees can choose between all the vision plans we offer. We are currently negotiating with three carriers: Davis Vision, EyeMed, and MetLife.

Will employees pay a monthly premium for vision and dental? *

No. Vision and dental insurance premiums are paid for you and your eligible dependents by your employer. However, you are responsible for deductibles, copays, and coinsurance payments.

Will school employees pay a monthly premium for life and accidental death and dismemberment (AD&D), and long-term disability insurance? *

No. Eligible school employees will receive basic life and AD&D, and basic LTD insurance through employer-paid benefits.

Employees will also be able to purchase supplemental life and AD&D, and supplemental LTD insurance for themselves and their eligible dependents.

What are Centers of Excellence? *

The Health Care Authority contracts with providers who excel in treating certain medical conditions. SEBB will offer Centers of Excellence for knee and hip replacement surgery, and spinal fusion for low to no cost to qualifying members. The Centers of Excellence programs are offered for those enrolled in certain UMP plans.

What carriers will offer plans through SEBB? *

Medical: The SEB Board has approved going forward with negotiations with Aetna, Kaiser Permanente Northwest, Kaiser Permanente Washington, Kaiser Permanente Options, Premera Blue Cross, Providence, and Uniform Medical Plan (UMP) as administered by Regence BlueShield. Final decisions on providers will be made in summer 2019.

Dental: We are going forward with negotiations with Delta Dental, Willamette Dental, and Uniform Dental Plan ad administered by Delta Dental.

Vision: We are going forward with negotiations with Davis Vision, EyeMed, and MetLife.

The SEB Board may make changes to the approved benefit designs until summer 2019.

My health plan year usually ends on October 31, but SEBB Program benefits are scheduled to start January 1, 2020. What will be done to address the time between when my current benefits end in 2019 and new SEBB Program benefits begin in 2020?

We have heard from most carriers, who indicate they will extend coverage through December 31, 2019. If you have questions, please contact your payroll or benefit office.

Will I be able to continue to see my current medical, dental, and vision provider?

It depends on the plans you choose. Given the number of plans offered, it is likely that your provider will be a member of one of the covered networks included in the SEBB Program.

I live in a rural area. Will my community providers be covered under the new SEBB plans?

The SEB Board and HCA are working to make sure all members have access to quality health plans and providers, regardless of where they live. After the procurement process is complete, we will have more detailed information about the plans and network options that will be available.

What benefits are the SEBB Program authorized to offer?

Under RCW 41.05.740, the SEBB Program is authorized to offer the benefits listed below. The SEB Board will decide which of these benefits will be offered.

  • Health care coverage
    • Medical
    • Dental
    • Vision
    • Prescription drug
  • Life insurance
  • Accidental death and dismemberment insurance
  • Liability insurance
  • Disability insurance

Are there any restrictions on additional benefits school districts, ESDs, and charter schools may offer?

Beginning January 1, 2020, school districts, ESDs, and charter schools may not offer any of the same benefits SEBB is authorized to offer (see list above) to any benefits-eligible employees and dependents. School districts, ESDs, and charter schools cannot offer these benefits independent from the SEBB Program, even if the SEB Board chooses not to offer them.

In addition, the law grants HCA exclusive authority over the salary reduction plan, so the following benefits are also excluded from being offered by school districts, ESDs, and charter schools.

  • Premium Payment Plan
  • Medical Flexible Spending Arrangement (FSA)
  • Dependent Care Assistance Program (DCAP)
  • Health Savings Account (HSA)

What optional benefits may school districts offer?

School districts, ESDs, and charter schools may offer some benefits, as long as they do not fall under the SEBB Program’s authority (see above). Any optional benefits that are offered by a school district, ESD, or charter school are considered an enhancement to the state’s definition of basic education, meaning the state will not contribute to their funding.

Optional benefits offered by school districts, ESDs, and charter schools may be paid by the employee, the employer, or both. Here are some examples of optional benefits.

  • Voluntary Employees Beneficiary Association (VEBA) plans
  • Cancer insurance
  • Travel insurance
  • Pet insurance

Plan costs

Will part-time employees have to pay a monthly premium for medical benefits?

Yes. All eligible employees will have the same premiums regardless of part- or full-time status. All eligible employees who enroll will pay a monthly premium based on the benefits they choose and whether they cover dependents.

Will part-time employees pay the same monthly premiums that full-time employees pay?

Yes. All employees working at least 630 hours a year who enroll in the SEBB Program will pay a monthly premium. The premium amount will depend on the medical plan you choose and whether you cover dependents.

What does the premium tier ratio mean for school employees?

The premium tier ratio is the highest share of what an eligible school employee will pay for SEBB insurance coverage based on the eligible dependents enrolled on the employee’s account.

For example, if a school employee’s SEBB medical premium is $50 per month (to cover the employee as subscriber only), the tier ratio table below shows the maximum that the school employee would pay each month to cover other eligible dependents enrolled under the medical plan:

Tier category

Premium tier ratio Employee's monthly medical premium (dollar amounts are for example only)

Subscriber only

1.00

$50

($50 x 1.00)

Subscriber and child(ren)

1.75

$87.50

($50 x 1.75)

Subscriber and spouse/state-registered domestic partner

2.00

$100

($50 x 2.00)

Subscriber and spouse/state-registered domestic partner and any child(ren)

3.00

$150

($50 x 3.00)

Are my health care costs (premiums, deductibles, out-of-pocket maximum, copays, and coinsurance) going to increase?

The answer is different for everyone. It depends on what you currently pay for benefits, the type of plan you have, and whether you cover dependents. It will also depend on your future decisions about plan selection and dependent coverage under the SEBB Program. HCA will be able to share cost information and monthly premiums after contracts are in place and the SEB Board votes on benefit design decisions such as deductibles, out-of-pocket maximums, copays, and coinsurance. This will not take place until mid-2019.

Premium surcharges

What are the premium surcharges?

The Legislature, under Section 504 of ESSB 6032, requires school employees to pay two premium surcharges, if they apply, in addition to the medical plan premiums each month, starting January 1, 2020.

  • Tobacco use premium surcharge
    A monthly $25 premium surcharge per account if the employee or any dependent (age 13 or older) enrolled on their SEBB medical plan uses a tobacco product.
  • Spouse or state-registered domestic partner coverage premium surcharge
    A monthly $50 premium surcharge if the employee has a spouse or state-registered domestic partner enrolled on their SEBB medical plan, and the spouse or state-registered domestic partner has elected not to enroll in their employer-based group medical insurance that is comparable to PEBB’s Uniform Medical Plan (UMP) Classic.

Tobacco use premium surcharge

What are “tobacco products”?

“Tobacco products" means any product made with or derived from tobacco that is intended for human consumption, including any component, part, or accessory of a tobacco product. This includes, but is not limited to, cigars, cigarettes, pipe tobacco, chewing tobacco, snuff, and other tobacco products. It does not include e-cigarettes or United States Food and Drug Administration (FDA)-approved prescription and over-the-counter tobacco cessation aids.

What is “tobacco use”?

Tobacco use means any use of tobacco products within the past two months. Tobacco use, however, does not include religious (as part of a formal tradition, rite, or ritual) or ceremonial (in connection with the practice of a traditional ceremony or ritual) use of tobacco.

How can I avoid paying the tobacco use premium surcharge?

If you attest within HCA’s enrollment timeframe that you and your enrolled dependents either have not used tobacco products in the last two months or are currently participating in a tobacco cessation program through your SEBB medical plan, then you will not have to pay the tobacco use premium surcharge.

Spouse or state-registered domestic partner coverage premium surcharge

If I do not have a spouse or state-registered domestic partner enrolled on my SEBB medical coverage, do I have to attest to the spouse or state-registered domestic partner coverage premium surcharge?

No. The premium surcharge will not apply to you.

If I have a spouse or state-registered domestic partner enrolled on my SEBB medical coverage, what happens if I don’t attest within the HCA’s timelines?

You will pay the monthly $50 premium surcharge in addition to your medical plan premium.

How can I find out more?

Information is available on our website, including:

We will continue to add information as it becomes available.

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