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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.

Questions about corona virus and eligibility during school closures? See Information about novel corona virus (COVID-19).

Yes. HCA hosted a webinar on February 21 with information on the rules and processes to follow. The webinar is posted on the BA website.

Yes. All employees working at least 630 hours during the school year who enroll in the SEBB Program will pay a monthly medical premium. The premium amount will depend on the medical plan employees choose and whether they cover dependents. There is no employee premium for dental, vision, basic life, basic accidental death and dismemberment, or basic long-term disability.

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.

COBRA participants (currently enrolled through their SEBB organization on December 31, 2019) may be able to enroll in continuation coverage (including COBRA) with SEBB. Once we receive information about their current enrollment from the SEBB organizations, the Health Care Authority will mail a SEBB Continuation Coverage Election Notice. In order to transition to SEBB Continuation Coverage, your SEBB Continuation Coverage (COBRA) Enrollment/Change form or SEBB Continuation Coverage (Unpaid Leave) Enrollment/Change form (including payment and applicable premium surcharges) must be received by the SEBB Program no later than 60 days after January 1, 2020 for benefits effective January 1, 2020. The SEBB Program will review enrollment forms to determine eligibility for SEBB Continuation Coverage and provide notification about next steps.

Only partially. PEBB K-12 employees will need to enroll themselves and their eligible dependents in the SEBB benefits via SEBB My Account and make new benefit selections to be covered under the SEBB Program for the 2020 plan year. 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.

State funding for K-12 benefits is historically 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 the Health Care Authority 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 benefits is similar to the PEBB benefits model, where state funds are distributed to state agencies and higher education institutions to forward to HCA along with employee premium contributions.

The formula for insuring SEBB organization employees and their dependents includes an estimated rate of employee waivers. If anticipated waivers weren’t factored in, that uncertainty would need to be funded by raising the amount 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.

Disallowing competing benefits is in the interest of ensuring HCA has the strongest negotiation position when setting rates with SEBB Program vendors and insurers. These limitations are in place to maintain the purchasing power that comes from consolidating all eligible school employees into one statewide risk pool through the SEBB Program. If an employer helps  school employees access a competing, non-SEBB Program insurance product, it would affect the risk profile of the SEBB Program population, which could affect the premiums or benefit structure of SEBB Program benefits.

Other reasons a SEBB organization cannot offer benefits authorized (but not offered) as part of the SEBB Program include:

  • Policy considerations that maximize the value of all benefits when they are used in combination.
  • Rate development that may have taken into account not offering certain benefit structures.

Note: In light of the passage of House Bill 2458, this guidance is being evaluated and necessary revisions will be made in the next several weeks.

School districts currently offer many types of accident policies, and it is not possible to determine by name alone whether the policies conflict with the SEBB Program’s authority. It appears that accident insurance policies likely conflict with the SEBB Program’s authority, but more information is needed about the exact coverage to make a final determination.  Examples of accident insurance brought to HCA’s attention have primarily included income replacement, which would conflict with the SEBB Program’s disability insurance benefit authority, or accident coverage that would conflict with the SEBB Program's accidental death and dismemberment benefit authority. Review of  accident insurance plan policies is necessary to ensure they don't conflict with the SEBB Program’s authority. This review began on December 1, 2019, and each year thereafter, when SEBB organizations that elect to offer optional benefits submit their reports to HCA describing any optional benefits they are offering to school employees.

Note: In light of the passage of House Bill 2458, this guidance is being evaluated and necessary revisions will be made in the next several weeks.

The SEB Board has the authority to offer these kinds of insurance products and can consider offering them in the future. However, the portfolio of medical benefits offered to school employees in 2020 is comprehensive and already includes coverage for conditions such as cancer, critical illness, and emergency transportation. Members can select from an array of plan choices to meet different levels of coverage needs. If school districts offers these types of plans in addition to the SEBB medical plans, it would affect the state’s negotiation position when setting rates and would reduce the ability to secure the best rates possible on behalf of members.

Note: In light of the passage of House Bill 2458, this guidance is being evaluated and necessary revisions will be made in the next several weeks.