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FAQs for school administrators

The following frequently asked questions (FAQs) help you understand the SEBB Program and how it affects your school district, educational service district, or charter school.

Last update: June 20, 2019

Most recent questions

The following are answers to questions we received over the last week. To view questions answered prior to the last seven days, see Questions by category.

Do different tiers equate different employer contribution amounts?

  • No. Districts will pay the same funding rate ($994 for 2020) regardless of which plan and which tier level employees select. The exception is employees who work between 180 and 630 hours and are offered SEBB benefits through locally negotiated agreements. See your payroll or benefits office for questions on whether you are eligible for this. For this group of employees only, the funding rate is different for each tier.

Will a PEBB My Account subscriber’s account and enrollment information transfer automatically to SEBB My Account?

  • Only partially. PEBB K-12 employees will need to enroll themselves and their eligible dependents in the SEBB Program via SEBB My Account and make new benefit selections to be covered under the SEBB Program for 2020 plan year. But they won’t have to provide verification documents for dependents previously enrolled under PEBB. However, if subscribers are adding new dependents that were not previously covered under PEBB, they will need to provide dependent verification for these new dependents.

Do holiday hours count toward the 630-hour threshold?

  • For the most part, holiday hours do not count. However, holiday hours do count for new hires that happen late in the school year. See How to determine eligibility.

Did any bills pass during the 2019 legislative session that pro-rate employee eligibility based on the number of hours worked in a school year?

  • No. Two bills raised the issue, but neither made it out of their originating committee.

Can children be enrolled in Apple Health for Kids instead of the SEBB Program?

  • No. If an employee or their children are currently enrolled in Washington Apple Health (Medicaid) coverage, and they are eligible for SEBB Program coverage, they must enroll themselves and their children in SEBB benefits. They cannot waive SEBB medical benefits for Apple Health coverage, but they can be enrolled in both. If they are a current Apple Health client, they can apply for the Premium Payment Program, which provides reimbursement for your SEBB Program medical premiums. Find out more on our Premium Payment Program webpage. If their children are on Apple Health for Kids with premiums (CHIP), that coverage will end December 31.

What happens if employees do not select coverage during open enrollment?

  • They will be defaulted into medical, dental, vision, life and accidental death and dismemberment, and long-term disability as a single subscriber in the default plans (to be determined). They will also be charged the tobacco use premium surcharge. Their dependents will not be enrolled. In addition, they won’t be able to change plans or enroll any eligible dependents until the next SEBB Program annual open enrollment or unless they have a special open enrollment event that allows the change, such as a marriage, birth, or adoption.

Some people have flex plans (also referred to as Flexible Spending Arrangements [FSAs] and dependent care accounts) that overlap with the January 1 go-live date. What do these people do?

  • We encourage anyone with an FSA or dependent care account to use up all their funds by their current plan’s deadline or December 31, 2019, whichever is earlier. Doing so will minimize the risk that they will forfeit funds. It may also lessen any confusion they might experience during the switch to the SEBB Program.

What is the cap on the number of administrator accounts a district can set up in SEBB My Account?

  • There is no limit. However, due to the sensitivity of SEBB My Account data, access should be given only to those within the organization who require access to perform their job function. HCA requires at minimum one benefit administrator, and, depending on the size of the district, recommends two or more benefit administrators for each district who are authorized to have full access and the ability to assign additional roles within SEBB My Account for their organization.

How do benefits administrators know who has or has not been verified?

  • Benefit administrators can view dependent verification requests from the SEBB My Account dashboard or through a downloadable report. More information on how to access these reports will be presented at benefits administrators training, scheduled in August and September.

Are Social Security numbers (SSN) required in SEBB My Account?

  • Yes, Social Security numbers (SSN) or Individual Tax Identification Numbers (ITIN) are required. If a dependent does not yet have an SSN or ITIN, they can begin benefits without an SSN/ITIN, but the dependent’s record must be updated with an SSN/ITIN as soon as possible after issuance.

Are subscribers able to update their own addresses in SEBB My Account?

  • No. Subscribers must notify their payroll or benefit office of address changes. The benefit administrators will update addresses through SEBB My Account.

What are the options for dependent verification?

  • A list of valid documents to verify dependents will be included in the School Employee Initial Enrollment Guide, mailed out in mid-September. It will also be posted in our School employees section of the website in September. Employees can upload their dependent verification documents for review via SEBB My Account, the online enrollment system. Alternately, employees can take their paper documents to their payroll or benefits office for review and approval.

Are premium surcharges pre-tax?

  • Yes. Monthly medical premiums, along with applicable premium surcharges, will be deducted from paychecks pretax, unless the employee arranges with their payroll or benefits office to have their premiums and applicable premium surcharges deducted post-tax.

Is marijuana included in the tobacco use premium surcharge?

  • No, only tobacco products are included.

Does the tobacco use premium surcharge attestation default to “Yes” in SEBB My Account?

  • Yes. If employees do not attest to the tobacco use premium surcharge during the first annual open enrollment or if they attest that they or their enrolled dependents use tobacco, they will be charged a monthly $25-per-account premium surcharge in addition to their monthly medical premium.

Does dependent verification need to be submitted before the annual open enrollment closes?

  • Yes. Documents must be submitted by 11:59 p.m., November 15, so they can be verified before January 1, 2020.

Top 10 questions

Are employees who aren’t considered full-time (like coaches, substitute teachers, etc.) eligible for benefits under the SEBB Program?

  • Yes, as long as they are employees of a school district or charter school, or are union-represented employees of an educational service district and work or are anticipated to work 630 hours during the school year. A school year means September 1 through August 31.

Did the Legislature make any adjustments to address discrepancies between headcount and FTE?

  • Benefits are funded by the Legislature on an FTE basis. To help bridge the difference between FTE and headcount, the collective bargaining agreement includes a “benefit allocation factor” (BAF). The benefit allocation factor (1.02 for certificated employees and 1.43 for classified employees) is multiplied by the FTE to arrive at the allocation.

Who will track the hours of an employee who works multiple jobs in a school district to determine their eligibility for benefits?

  • School personnel staff will track part-time employees’ hours for all positions they fill within the district. Only hours worked within one school district, charter school or ESD will count toward the 630 hours. School employees can add together hours from multiple jobs within a district, but they cannot add together hours from multiple districts.

Will pooling still occur in the SEBB Program?

  • Yes, but it will happen at the state level. The state estimates how many employees will waive coverage. Factoring in the expectation that some employees will waive medical coverage allows us to offer consistent, affordable employee monthly premiums throughout the year.

If an employee adds their family, how much will it cost the district?

  • The district pays the same funding rate per SEBB benefits-eligible employee, regardless of whether they enroll dependents or which plans they choose. The funding rate is calculated based on the statewide average number of dependents per SEBB benefits-eligible employee.

If an employee waives coverage, does the district still pay the full employer contribution?

  • Yes. Employees can only waive medical. They cannot waive dental, vision, or other benefits. The funding rate calculation assumes a certain percentage of employees will waive medical coverage, which reduces the average amount of employer funding needed per employee.

Will districts still pay the retiree carve-out (K-12 remittance)?

  • Yes. School districts will pay the K-12 remittance for all SEBB Program benefits-eligible employees. The remittance is part of the overall funding rate.

What help will HCA offer for the process of dependent verification?

  • HCA has awarded a contract to an independent contractor to alleviate the bulk of dependent verification during the first annual open enrollment period in 2019.
    Please note, however, this is a one-time solution. After the first annual open enrollment period, districts will need to manage their employees’ dependent verification for special open enrollments, new-hire enrollments, and subsequent annual open enrollments.
    Employees will need to verify all their dependents enrolled in SEBB. After the first annual open enrollment, subscribers won’t have to re-verify dependents that are already enrolled in SEBB. The exception is employees who are currently members in the Public Employees Benefits Board (PEBB) Program. Their dependent verification status will be transferred over to SEBB.

Will employees be able to enroll using paper forms?

  • School employees will be directed to enroll online using a computer, tablet, or smartphone. However, for those who cannot enroll online, paper enrollment forms will be available.

What is dual enrollment, and why isn’t it allowed?

  • If a school employee is eligible to enroll in the SEBB Program and is also eligible as the spouse, state-registered domestic partner, or dependent of another school employee, we call that “dual enrollment.” Dual enrollment is not allowed for medical, dental, or vision coverage. 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.

Questions by category

Can school districts, charter schools, and ESDs with union-represented employees opt out?

No. The SEBB Program applies to all school districts and charter schools,  and ESDs with union-represented employees within Washington.

Can implementation of the SEBB Program be delayed for one year?

The Legislature, the SEB Board, and the Health Care Authority (HCA) are committed to having everything in place for implementation on January 1, 2020. There is no consideration of delaying implementation.

Will school board members be covered in the SEBB Program?

No, only school employees anticipated to work 630 hours or more during the school year are eligible. However, school board members are eligible to contract with PEBB Program for coverage, just as they were before.

Will SEBB coverage meet the affordability requirement under the Affordable Care Act?

Yes, the SEBB Program will meet the affordability requirements.

Will districts be responsible for preparing Forms 1094 and 1095?

Yes. Districts will continue to be responsible for preparing IRS Forms 1095, providing copies of Forms 1095 to employees and former employees (e.g., retirees, COBRA enrollees), and filing Forms 1094 (and copies of Forms 1095) with the IRS.
HCA currently provides districts with prior-year medical enrollment data to support their preparation of Forms 1095 in early January each year. HCA will continue to provide data files to districts that include all employee enrollment data, as well as former employee enrollment data for those former employees enrolled in self-insured coverage.

Has there been consideration of adopting the Affordable Care Act (ACA) rules for eligibility of substitutes?

No. The ACA requirements are more restrictive than state law, and the SEB Board cannot make a requirement that is more restrictive than statute.

RCW 41.05.740 (6)(d)(ii) reads: “… the school employees' benefits board's criteria shall be no more restrictive than requiring that a school employee be anticipated to work at least six hundred thirty hours per school year to be benefits eligible …”

How will HCA communicate information to school districts, ESDs, charter schools, and interested people?

Information is available on our website, including:

  • SEBB fact sheets and tool kits about different aspects of SEBB Program.
  • Approved board resolutions that establish eligibility and benefit plans to date.
  • General FAQs for members that explain eligibility and enrollment situations.

We will continue to add information as it becomes available.

You can also sign up to receive email updates on:

Is HCA adding additional staff to support this?

Yes. HCA is adding staff primarily in the Employees and Retirees Benefits (ERB) Division, whose jobs will be to make the transition to the SEBB Program as smooth as possible. Personnel in school districts, educational service districts, and charter schools will retain a very active role in assessing eligibility and aiding employees with enrollment. ERB staff will provide training and support. Additionally, ERB will provide information to school employees ahead of the October 2019 open enrollment to assist them in making benefit selections.

Will retirees participate in SEBB?

No. For now, retirees are eligible to enroll in the PEBB Program.

Do we need to get permission from employees to give their information to HCA?

No, RCW 41.05.021(1)(a) and RCW 28A.400.280(3) allow the HCA access to employee information.

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. Employee benefit eligibility and coverage period are based on the school year.

Districts are required to pay the full retiree remittance fee for (as an example) a .75 FTE employee. Is the district going to have the ability to charge the employees for that difference?

No, employers are responsible for the entire retiree remittance fee for all eligible employees. The retiree remittance is included in the funding rate the district pays for each eligible employee.

If a substitute qualifies for coverage mid-year and declines medical benefits, does the district continue to pay the funding rate to HCA?

Yes. Employees can waive medical coverage, but cannot waive other benefits for which they are eligible (dental, vision, basic life and accidental death and dismemberment [AD&D], and basic long-term disability insurance). The district pays the full funding rate for every eligible employee (when they become eligible) for the school year.

Will school districts, charter schools, and ESDs with union-represented employees have to pay for wellness incentives?

Yes, school districts, ESDs with represented employees, and charter schools will pay the wellness incentive, but it is already included as a component within the funding rate.  There will not be an additional charge.

Will pooling still occur in the SEBB Program?

Yes, but it will happen at the state level. The state estimates how many employees will waive coverage. Factoring in the expectation that some employees will waive medical coverage allows us to offer consistent, affordable employee monthly premiums throughout the year.

If an employee adds their family, how much will it cost the district?

The district pays the same funding rate per SEBB benefits-eligible employee, regardless of whether they enroll dependents. The funding rate is calculated based on the statewide average number of dependents per SEBB benefits-eligible employee.

Will the school district, ESD, or charter school be required to pay the same amount of the medical premium and all the complete premium for employee dental, vision, LTD, life and AD&D, regardless of the employee’s FTE, as long as they meet the 630-hour criteria?

Yes, that is correct.

Will districts still pay the retiree carve-out (K-12 remittance)?

Yes. School districts will pay the K-12 remittance for all SEBB Program benefits-eligible employees. The remittance is part of the overall funding rate. See “What’s included in the funding rate?”

What’s included in the funding rate districts pay to HCA?

For every SEBB benefits-eligible employee, the employer will pay the funding rate, which includes the following:

  • Medical premium contribution
  • 100 percent dental premium
  • 100 percent vision premium
  • 100 percent basic life and accidental death and dismemberment premium
  • 100 percent basic long-term disability premium
  • K-12 remittance (for retirees)
  • Administration

Will SEBB funding be tied to prototypical school funding?

SEBB Program base funding is calculated using the prototypical model and adjusted by the “benefit allocation factor” (BAF). See question below.

Did the Legislature change the benefit allocation funding (BAF) rate of 1.02 for certificated employees and 1.43 for classified employees?

The benefit allocation factor (BAF) is part of the collective bargaining agreement, which the Legislature has approved.

Did the Legislature make any adjustments to address discrepancies between headcount and FTE?

Benefits are funded by the Legislature on an FTE basis. To help bridge the difference between FTE and headcount, the collective bargaining agreement includes a “benefit allocation factor” (BAF). The benefit allocation factor (1.02 for certificated employees and 1.43 for classified employees) is multiplied by the FTE to arrive at the allocation.

What will the funding source be for the school districts going forward? 

The state will provide funding on an FTE basis with a benefit allocation factor applied (see question above). Funding will still come from the state. Employees will also be responsible for a portion of their medical premium.

How will the funding rate account for job shares?

If two individuals sharing one job are each anticipated to work more than 630 hours, they will both be eligible for SEBB Program benefits. The district will be required to pay the employer’s share of the benefit costs for each eligible employee.

Why is the Legislature passing funding through the districts for SEBB benefits rather than providing it directly to HCA?

State funding for K-12 benefits is currently distributed to districts as part of general apportionment. In order to provide funding directly to HCA, the Legislature would need to restructure the K-12 benefit funding process in the budget bill, and HCA would still need to work with the districts to collect employee premium contributions and funding for any eligible staff not covered by the state funding. This funding model for SEBB Program benefits is similar to the PEBB Program benefits model, where state funds are distributed to state agencies and higher education institutions to forward to HCA along with employee premium contributions.

Will there be funding parity between PEBB and SEBB?

Funding parity was addressed by the Legislature in Engrossed Substitute Senate Bill 6241, which intended for insurance benefit allocations for school employees to be no less than rates for state employees. The amount of funding provided for PEBB Program and SEBB Program benefits will be addressed during standard legislative operating budget processes.

Who is doing the “contributing” in RCW 41.56 and 41.59?

The contributions referred to in these laws are supplied by the state, which negotiates directly with a coalition of union representatives to determine the employer contribution. During the budget process, the Legislature determines whether to fund the negotiated agreement as part of the regular state budget.

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

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

Are the tobacco use and spouse or state-registered domestic partner coverage premium surcharges paid by employees? Was that discussed in collective bargaining?

The premium surcharges are paid by employees. The Legislature mandated this, and the collective bargaining tentative agreement describes it.

Will districts receive money or funded FTEs to implement the system of record and data transfer required for SEBB?

No. The Legislature did not provide funding for this. However, HCA will provide technical assistance to support the transition to the SEBB Program. The Legislature did approve funding to hire a vendor to assist with dependent verification during the first annual open enrollment.

How do current PEBB rules inform the SEB Board’s policy decisions?

The SEB Board makes policy decisions entirely separate from PEBB Program rules. However, HCA does use its understanding of various issues that it has developed in administering the PEBB Program to help inform the SEB Board in its decision-making process.

*Added or updated May 28, 2019

Do staff who are taking FMLA leave still get benefits? *

Yes. When an employee is approved for Family and Medical Leave Act (FMLA), they continue their benefits, per federal law. The employee is still responsible for paying their portion of the premiums. See WAC 182-31-110. We are awaiting final rules for the state Paid Family and Medical Leave Program before discussing impacts to employees enrolled in the SEBB Program.

Are employees who aren’t considered full-time (like coaches, substitute teachers, etc.) eligible for benefits under the SEBB Program?

Yes, as long as they work or are anticipated to work 630 hours for a school district, educational service district, or charter school during the school year. A school year means September 1 through August 31.

How do we decide if an employee is anticipated to work 630 hours?

District administrators will decide this, based on the SEBB Program qualifications.

When do new employees start receiving benefits?

It depends on when they are hired.

  • 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.
  • 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 but anticipated to work 630 hours or more the following year enter 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 work at least 17.5 compensated hours a week in six of the last eight full or partial weeks before summer break. 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 work at least 17.5 compensated hours a week in six of the last eight full or partial weeks before the end of the school year (August 31). Their benefits would begin the first of the month after they begin work.

If an employee meets the eligibility requirement of working 630 hours within the school year on May 1, do we offer them coverage through August 31 (the end of the school year)?

Yes. The employee’s SEBB benefits would begin June 1 and run through August 31. (See "When do new employees start receiving benefits?")

If an employee has worked 630 hours and enrolls in SEBB, and then their work schedule changes so they will work less, do they lose coverage?

No. They retain coverage until the end of the school year. Their premiums will not change, unless they have a special open enrollment event and change their coverage.

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.

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 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.

What happens when an employee reaches 630 hours but decides not to bid or take shifts for the rest of the year? Do districts still provide benefits?

Yes. Districts will provide benefits to any employee who works or is anticipated to work 630 hours within the school year.

If employees leave, does their coverage end at the end of the month?

Yes. If an employee leaves in the middle of the month, the district covers them until the end of that month.

Who will track the hours of an employee who works multiple jobs in a school district to determine their eligibility for benefits?

School personnel staff will track part-time employees’ hours for all positions they fill within the district.

How do we track employees who work across multiple school districts?

Only hours worked within the same school district will count toward the 630 hours. School employees cannot add together hours from multiple districts. Only hours from one district can count toward eligibility.

When does employee eligibility for coverage through the SEBB Program end?

The employer contribution toward SEBB benefits ends the last day of the month in which the school year ends (August 31). The employer contribution toward SEBB benefits will end earlier than the end of the school year if one of the following occurs:

  • The district, ESD, or charter school terminates the employment relationship. Eligibility for the employer contribution ends the last day of the month in which the employer-initiated termination notice is effective.
  • The school employee terminates the employment relationship. Eligibility for the employer contribution ends the last day of the month in which the school employee’s resignation is effective.
  • The school employee’s work pattern is revised such that the employee is no longer anticipated to work 630 hours during the school year. Eligibility for the employer contribution ends as of the last day of the month in which the change is effective.

What about transfers between districts?

Employees 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:

  • The employee was eligible for the employer contribution toward SEBB benefits in the position they are leaving; and
  • The employee is anticipated to be eligible for the employer contribution toward SEBB benefits in their new position.

If employees don’t attest that they don’t use tobacco, will they be charged the tobacco use premium surcharge?

Yes. To avoid the tobacco use premium surcharge, employees must attest that they and their dependents do not use tobacco. For more on this, visit the Tobacco use surcharge webpage.

Is the tobacco use premium surcharge per person? 

No, the tobacco use premium surcharge is per household. If there is at least one person in the household enrolled in the SEBB Program age 13 or older who uses tobacco, you will be charged the surcharge. You will not be charged more for additional tobacco users. Find out more on the Tobacco use premium surcharge webpage. 

Will enrollment materials be available in languages other than English?

SEBB My Account, the online enrollment system, will only be available in English for now. However, non-English speakers will be able to enroll in SEBB using paper forms. The SEBB Program will provide all of our paper publications and enrollment forms in additional languages upon request. Additional supported languages include: Amharic, Burmese, Cambodian, Chinese, Korean, Laotian, Oromo, Punjabi, Romanian, Russian, Somali, Spanish, Swahili, Tagalog, Tigrigna, Ukrainian, and Vietnamese. To request materials in supported languages, see HCA’s Language Access webpage.

Will employees be able to enroll using paper forms?

School employees will be directed to enroll online using a computer, tablet, or smartphone. However, for those who cannot enroll online, paper enrollment forms will be available.

Will HCA create all open enrollment materials, benefit summaries, enrollment forms, etc.?

Yes. The SEBB Program will create open enrollment materials — including benefit summaries, enrollment forms, website content, email messages, flyers, posters, articles, and other communications. HCA will  depend on the districts to distribute much of the information to ensure that all eligible school employees receive consistent information and follow the same processes.

We are developing information for administrators preparing for this change and for all school employees regarding open enrollment.

Will the amount of $35,000 of life insurance apply to all employees, with no additional employer-paid life insurance allowed?

Yes, that is correct. Employees can buy supplemental life insurance if they choose.

When the SEBB Program becomes effective on January 1, 2020, will the amount met toward employees’ deductibles in 2019 carry over?

No. Current plans should run until the end of 2019. January 1, 2020 will begin a new plan year and deductibles will start over.

What benefits can the SEBB Program 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, charter schools and ESDs with union-represented employees may offer?

Beginning January 1, 2020, school districts, charter schools and ESDs with union-represented employees 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, charter schools, and ESDs with union-represented employees 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 to employees who are eligible for SEBB Program benefits.

  • 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, charter schools and ESDs with union-represented employees 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, charter school or ESD with union-represented employees 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, charter schools and ESDs with union-represented employees 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
  • Employee assistance programs

Is it true that the carriers participating in the SEBB Program also have to be part of the individual market exchange?

Yes. In 2018, the Washington State Legislature passed Engrossed Substitute House Bill 2408, which calls for this participation.

How many of the SEBB Program fully insured medical carriers also currently provide PEBB insurance?

Kaiser Foundation Health Plan of the Northwest and Kaiser Foundation Health Plan of Washington currently offer PEBB insurance. The other carriers we are currently negotiating with are Kaiser Foundation Health Plan of Washington Options and Premera Blue Cross.

Is HCA looking at a third-party administrator for a fully insured plan?

No. Typically, fully insured health care plans do not have a third-party administrator (TPA). TPAs are used to perform administrative services on behalf of an employer that sponsors a self-insured health plan.

What help will HCA offer for the process of dependent verification?

HCA has recently awarded a contract to an independent contractor to alleviate the bulk of dependent verification during the first annual open enrollment period in 2019.

Please note, however, this is a one-time solution. After the first open enrollment period, districts will need to manage their employees’ dependent verification for special open enrollments, new-hire enrollments, and subsequent annual open enrollments.

If an outside vendor does dependent verification, how do we know when employees are verified?

Both benefits administrators and subscribers will be able to see which dependents have been verified or denied on SEBB My Account, our online enrollment system.

Do dependents who are covered by our organization’s current insurance have to be re-verified?

Yes. Employees will need to verify all their dependents in SEBB. After the first open enrollment, subscribers won’t have to re-verify dependents that are already enrolled in SEBB.

The exception is employees who are currently members in the Public Employees Benefits Board (PEBB) Program. Their dependent verification status will be transferred over to SEBB.

If districts are currently participating in PEBB, do they have to do dependent verification for SEBB?

No. If employees are enrolled in PEBB now, their dependents' verification status will transfer over to SEBB. Any dependents not previously enrolled will have to be verified.

If an employee brings in physical dependent verification documents to their local benefits administrator to verify, does the local benefits administrator verify them, or should the documents be uploaded to SEBB My Account for verification?

If the document proves eligibility of the dependent, the local benefits administrator can verify it and enter that decision in SEBB My Account. You don’t need to upload the document or keep it.

If the document submitted does not prove eligibility, that document will need to be uploaded into SEBB My Account for further review. If the document is not accepted as valid dependent verification it will be denied and the documentation will be kept in SEBB My Account for clarification or appeal for 180 days.

What happens to documentation for dependent verification after it’s approved or denied?

After the dependent verification document is approved, it is kept for a few days and then deleted. If a paper document is given to the benefits administrator and approved, it can be returned to the employee. If the verification is denied, the uploaded document is kept until any appeals are completed.

Are dependents enrolled in a plan at the same time as employees, or only after dependent verification is finished?

Dependents are enrolled in plans only after the dependent eligibility document is approved. During open enrollment, dependents will be enrolled at the same time as the employee and will be verified before the employee’s coverage begins the following January.

For new hires and during special open enrollments, there may be a difference between when the employee is enrolled and the dependent is enrolled, based on when verification is approved and the reason for the dependent’s enrollment.

Are districts required to use SEBB My Account?

Yes. SEBB My Account is the exclusive online enrollment system for the SEBB Program. It can be used during the annual open enrollment, for new hires, and during special open enrollments. HCA will provide in-person training for benefits administrators (staff who manage payroll and benefits) in August and September, as well as online materials and training videos. For employees who don’t have access to an electronic device, paper forms will be available.

Will members need to go to a different portal to enroll in supplemental life, AD&D, and LTD insurance and for theirMedical FSA enrollments? Or will it all be in SEBB My Account?

Employees will need to go to different websites to enroll in life and accidental death and dismemberment, long-term disability, Medical Flexible Spending Arrangements (FSA), and health savings accounts (HSA). They can access those websites from SEBB My Account.

Do employees need to use SEBB My Account to waive medical coverage so they do not default to a medical plan?

Employees who want to waive medical coverage must do so either on SEBB My Account or with paper forms. If they waive medical coverage, they will not default into a medical plan. If they do not officially waive medical coverage and do not enroll, they will default into a medical plan chosen by the SEBB Program.

If an employee brings in dependent verification documents to the benefits administrator to verify, do we just verify it for them, or do we upload it to SEBB My Account for them? 

If the document proves eligibility of the dependent, just verify it. You don’t need to upload the document or keep it.

If it does not prove eligibility, upload the document for further review and deny it. The document will be kept for clarification or appeal.

Do eligible employees use SEBB My Account to enroll in all of the SEBB Program’s basic and supplemental insurance benefits?

Not quite. Employees use SEBB My Account for enrolling in most of the benefits, but not all.

Employees enroll in medical, dental, vision, basic life and accidental death and dismemberment (AD&D), and both basic and supplemental long-term disability (LTD) insurance on SEBB My Account.

Employees will need to go to different websites to enroll in supplemental life and AD&D insurance, Medical Flexible Spending Arrangement (FSA), and Dependent Care Assistance Program (DCAP). The links to these respective websites will be available from within SEBB My Account.

A paper form will be available for employee contribution elections in health savings accounts (HSA) and provided to the district benefits administrator.

Will we use SEBB My Account for premium surcharge attestation?

Yes, we’re building functions into SEBB My Account for attestations regarding the tobacco use and spouse or state-registered domestic partner coverage premium surcharges.

Will SEBB My Account work for people who are visually impaired?

Yes, SEBB My Account is being developed and tested to follow the Americans with Disabilities Rehabilitation Act (ADA) Website Content Accessibility Guidelines (WCAG) 2.0. This includes making the system friendly for screen readers to read textual information.

Who will administer COBRA and other forms of continuation coverage?

The Health Care Authority (HCA) will administer the continuation coverage for COBRA and unpaid leave starting January 1, 2020. At that time, once a SEBB organization notifies the SEBB Program through SEBB My Account that a school employee has lost eligibility for SEBB Program benefits, HCA will mail a SEBB Continuation Coverage Election Notice booklet to the subscriber and/or any enrolled family members 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 SEBB My Account. A paper enrollment form will be included in the SEBB Continuation Coverage Election Notice.

Will employees and dependents enrolled in COBRA (and who have not exhausted their coverage) as of December 31, 2019, be eligible to enroll in COBRA through the SEBB Program on January 1, 2020?

Yes. Employees and dependents are eligible to enroll in the SEBB Program’s medical, dental, and vision coverage on a self-pay basis (they pay the entire premium) for the remaining time that COBRA allows.

If an employee takes leave without pay (LWOP), does the employer pay the full amount for an employee’s insurance coverage?

Employers will continue to pay the full employer contribution for employees who go on approved LWOP if they have already worked 630 hours during the school year and are anticipated to return to work. 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 employer does not make the employer contribution. When the school employee returns to work after their LWOP, the employer will determine whether the employee is benefits eligible.

What is “dual enrollment”?

If a school employee is eligible to enroll in the SEBB Program and is also eligible as the spouse, state-registered domestic partner, or dependent of another school employee, we call that “dual enrollment.” Dual enrollment is not allowed for medical, dental, or vision coverage. An employee could waive medical coverage for themselves and enroll as a dependent on their spouse’s, state-registered domestic partner’s, or parent’s medical coverage. However, they must enroll in dental, basic life and AD&D, and basic long-term disability insurance under their 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.

If an employee enrolls in SEBB Program benefits, and their spouse is enrolled in the PEBB Program, can they cover each other as dependents on each other’s account?

Yes. If they cover each other, the spouse’s or state-registered domestic partner’s primary coverage would be through the PEBB Program and the secondary coverage would be through the SEBB Program. The employee's primary coverage would be through the SEBB Program and their secondary coverage would be through the PEBB Program. In this scenario, they would not incur the monthly $50 spouse or state-registered domestic partner coverage premium surcharge.

However, if your spouse or state-registered domestic partner waives medical coverage and enrolls on your account (or vice versa), you would incur the monthly $50 spouse or state-registered domestic partner coverage premium surcharge in addition to your monthly premiums.

Can dependent children be on two accounts?

No. SEBB coverage is limited to a single enrollment per individual. If you and your spouse or state-registered domestic partner both enroll in the SEBB Program, you can decide which account your children go on.

What if an employee doesn’t select health plans during the first annual open enrollment and is defaulted into plans that aren’t available in their area?

If employees do not choose medical, dental, and vision plans, they will be enrolled in default plans that are available in their area.

If an employee works for more than one school district, how will we know if they are dual enrolled in benefits under the SEBB Program?

HCA’s system of record only allows employees to be enrolled once. If an employee is eligible for benefits in more than one district, the employee will choose which district will be their employer for purposes of SEBB Program enrollment.

Can an employee who qualifies for Apple Health (Medicaid) waive SEBB medical coverage?

No. You can only waive SEBB medical coverage if you’re enrolled in other employer-based group medical insurance, a TRICARE plan, or Medicare. Apple Health (Medicaid) does not qualify. However, you can be enrolled in both SEBB benefits and Apple Health. Your SEBB Program benefits will be your primary health plan and will pay first for covered services. Your Apple Health coverage may pay copays, deductibles, and other services that your SEBB benefits don’t cover.

Can an employee cover a retired spouse who is enrolled in Medicare Part A and Part B?

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

If an employee's spouse is eligible for Medicare Part A and Part B but does not enroll in it, and the employee enrolls the spouse on my SEBB account, do they pay a spouse or state-registered domestic partner coverage premium surcharge?

No. Medicare is not employer-based group medical coverage, so the premium surcharge does not apply. WAC 182-30-050 (2) says: "'Employer-based group health plan’ means group medical, group vision, and group dental related to a current employment relationship. It does not include medical, vision, or dental coverage available to retired employees, individual market medical or dental coverage, or government-sponsored programs such as Medicare or Medicaid.”

Can children be enrolled in Apple Health for Kids instead of the SEBB Program?

No. If an employee or their children are currently enrolled in Washington Apple Health (Medicaid) coverage, and they are eligible for SEBB Program coverage, they must enroll themselves and their children in SEBB benefits. They cannot waive SEBB medical benefits for Apple Health coverage, but they can be enrolled in both. If they are a current Apple Health client, they can apply for the Premium Payment Program, which provides reimbursement for your SEBB Program medical premiums. Find out more on our Premium Payment Program webpage. If their children are on Apple Health for Kids with premiums (CHIP), that coverage will end December 31.

Can employees waive SEBB coverage?

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

However, they must enroll in SEBB dental, vision, basic life and accidental death and dismemberment (AD&D), and basic long-term disability insurance for yourself, regardless of whether they waive SEBB medical coverage.

If they waive SEBB medical coverage:

  • They cannot enroll your 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, beginning January 1, 2020, 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.

Can employees waive dental and/or vision coverage?

No. All SEBB benefits-eligible employees will be enrolled in dental, vision, basic life and accidental death and dismemberment, and basic long-term disability.

Can dependents be enrolled in dental and vision if they’re not enrolled in medical?

Yes. Dependents must be enrolled in the same health plans as the subscriber. So if the subscriber is enrolled in dental and vision coverage, their dependents can be enrolled in the same dental and vision plans. This applies whether the subscriber is enrolled in medical or waives it.

If an employee waives coverage, does the district still pay the full employer contribution?

Yes. Employees can only waive medical. They cannot waive dental, vision, or other benefits. The funding rate calculation assumes a certain percentage of employees will waive medical coverage, which reduces the average amount of employer funding needed per employee.

Why do school districts pay an employer contribution for employees who waive SEBB Program coverage?

The formula for insuring school district, ESD, and charter school 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 employees pay for their 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.

If a substitute qualifies for coverage mid-year and waives medical benefits, does the district continue to pay the funding rate to HCA?

Yes. Employees can waive medical coverage, but cannot waive other benefits for which they are eligible (dental, vision, basic life and accidental death and dismemberment [AD&D], and basic long-term disability insurance). The district pays the full funding rate for every eligible employee (when they become eligible) for the school year.

Can an employee who qualifies for Apple Health (Medicaid) waive SEBB medical coverage?

No. They can only waive SEBB medical coverage if they’re enrolled in other employer-based group medical insurance, a TRICARE plan, or Medicare. Apple Health (Medicaid) does not qualify. However, they can be enrolled in both SEBB benefits and Apple Health. Their SEBB Program benefits will be their primary health plan and will pay first for covered services. Their Apple Health coverage may pay copays, deductibles, and other services that that SEBB benefits don’t cover.

If an employee's spouse has a retiree policy that covers the employee, can they waive medical?

No. They can only waive SEBB medical coverage iftheyenrolled in other employer-based group medical insurance, a TRICARE plan, or Medicare. Retirement policies are not employer-based, so they do not qualify.

If an employee wants to waive medical coverage, do they use SEBB My Account or a paper form?

Employees who want to waive medical coverage can use either SEBB My Account or paper forms. If they waive medical coverage before the end of open enrollment, they will not default into a medical plan. If they do not waive medical coverage or do not enroll in a plan within the SEBB Program’s timelines, they will default into a medical plan chosen by the SEBB Program.

If employees waive medical coverage, do they have to pay the premium surcharges?

No. The tobacco use and spouse or state-registered domestic partner coverage premium surcharges do not apply if they waive medical coverage.

Do employees need to use SEBB My Account to waive medical coverage?

Employees who want to waive medical coverage can do so either on SEBB My Account or with paper forms. If they do not officially waive medical coverage and do not enroll, they will default into a medical plan chosen by the SEBB Program.

What happens if employees do not select coverage during open enrollment?

They will be defaulted into medical, dental, vision, life and accidental death and dismemberment, and long-term disability as a single subscriber in the default plans (to be determined). They will also be charged the tobacco use premium surcharge. Their dependents will not be enrolled. In addition, they won’t be able to change plans or enroll any eligible dependents until the next SEBB Program annual open enrollment or unless they have a special open enrollment event that allows the change, such as a marriage, birth, or adoption.

What if an employee is defaulted into plans that aren’t available in their area?

If employees do not choose medical, dental, and vision plans, they will be enrolled in default plans that are available in their area.