How to determine eligibility

Learn about SEBB Continuation Coverage options for school employees.

What continuation coverage options are available?

The SEBB Program offers one or more ways for you and your dependents, if eligible, to transition your existing COBRA coverage (for those currently enrolled in COBRA through their school district before 2020) or continue SEBB Program coverage.

  1. SEBB Continuation Coverage (COBRA)
    A temporary extension of SEBB health plan or other 2019 employer-based coverage available to SEBB members defined as qualified beneficiaries under federal Consolidated Omnibus Budget Reconciliation Act (COBRA) rules, and for state-registered domestic partners and their children, based on RCW 26.60.015 and SEBB policy resolution that extends SEBB coverage for dependents not otherwise eligible for COBRA. Coverage may be temporarily extended only if the SEBB member experiences a qualifying event.
  2. SEBB Continuation Coverage (Unpaid Leave)
    A temporary extension of SEBB insurance coverage for employees who lose eligibility for the employer contribution toward insurance coverage due to specific types of leave.

Who can elect SEBB Continuation Coverage?

If transitioning from a SEBB organization on December 31, 2019

Different rules apply for those who are currently on continuation coverage through a school district, charter school, or educational service district (SEBB organization), or who may lose eligibility for health care coverage provided by a SEBB organization on December 31, 2019 and are not eligible for SEBB coverage. See the SEBB Continuation Coverage Election Notice and Insert for more information.

  • A school employee and their dependents who are enrolled in medical, dental, or vision under a group plan offered by a SEBB organization on December 31, 2019, who loses eligibility because the school employee is not eligible under WAC 182-31-040. 
  • A dependent of a SEBB eligible school employee who is enrolled in medical, dental, or vision under a school employee's account on December 31, 2019, who loses eligibility because they are not an eligible dependent under 182-31-040.
  • A dependent of a school employee who is continuing medical, dental, or vision coverage through a SEBB organization on December 31, 2019, who may elect to finish out their remaining months, up to the maximum number of months authorized by COBRA for a similar event.

If losing SEBB health plan coverage due to a qualifying event

Qualified beneficiaries (employees, spouses, or dependent children) under federal COBRA continuation coverage, or state-registered domestic partners and their dependent children who are not qualified beneficiaries under federal COBRA rules, are entitled to elect SEBB Continuation Coverage (COBRA) if they lost SEBB health plan coverage due to a qualifying event.

Each individual (employee or dependent) who lost their SEBB employer-based group health plan due to a qualifying event has an independent election right to SEBB Continuation Coverage (COBRA). For example:

  • The employee’s eligible spouse or state-registered domestic partner may elect continuation coverage, even if the employee does not.
  • The employee or their eligible spouse or state-registered domestic partner may elect continuation coverage for one, some, or all eligible dependent children. Certain newborns, newly adopted children, and children identified under a court order or National Medical Support Notice may also be eligible for continuation coverage.
  • The employee or their eligible spouse or state-registered domestic partner may elect continuation coverage on behalf of their eligible children.

An employee who lost their SEBB employer-based group health plan due to the following events may elect SEBB Continuation Coverage (Unpaid Leave) for themselves and eligible dependents:

  • Authorized leave without pay from a SEBB organization.
  • Employment ends due to a layoff.
  • Reverting to a position that is not eligible for the employer contribution toward insurance coverage.
  • Appealing a dismissal action.
  • Receiving time-loss benefits under workers’ compensation.
  • Applying for disability retirement.
  • Called to active duty in the uniformed services as defined under USERRA.

If an employee does not elect this coverage, their dependents do not have independent election rights to SEBB Continuation Coverage (Unpaid Leave). Their dependents may have an independent right to SEBB Continuation Coverage (COBRA).

When is continuation coverage available?

The SEBB Program will offer continuation coverage to you or your covered dependents after you, your survivors, a representative acting on your behalf, or your employer notifies the SEBB Program that you or your dependents are no longer eligible for benefits.

When a qualifying event occurs and the SEBB Program is properly notified, we will send a SEBB Continuation Coverage Election Notice to you and/or your dependents at the address(es) we have on record. The notice provides information on how to continue SEBB health plan coverage.

What is SEBB Continuation Coverage (COBRA)?

SEBB Continuation Coverage (COBRA) is a continuation of health plan coverage offered when SEBB health plan coverage ends because of a qualifying event. After a qualifying event occurs, the SEBB Program is required to offer SEBB Continuation Coverage (COBRA) to each person who is a qualified beneficiary, and to state-registered domestic partners and their children, based on RCW 26.60.015 and SEBB policy resolution that extends SEBB coverage for dependents not otherwise eligible under federal COBRA rules. An employee's state registered domestic partner and the state registered domestic partner's children may continue SEBB insurance coverage on the same terms and conditions as spouses and other eligible dependents under COBRA.

You, your spouse, your dependent children, and your state-registered domestic partner and their children could become qualified beneficiaries if coverage in a SEBB health plan is lost because of a qualifying event. Each qualified beneficiary has independent election rights. Those choosing to elect SEBB Continuation Coverage (COBRA) must pay the monthly premium and applicable premium surcharges. The type of qualifying event determines how long you may continue SEBB Continuation Coverage (COBRA).

Who is entitled to SEBB Continuation Coverage (COBRA)?

Qualified beneficiaries (employees, spouses or former spouses, or dependent children) under federal COBRA rules, or current or former state-registered domestic partners and their dependent children who are not qualified beneficiaries under federal COBRA rules, are entitled to continue SEBB health plan coverage by electing SEBB Continuation Coverage (COBRA) if they lost SEBB health plan coverage due to a qualifying event (see below).

Qualifying events for SEBB Continuation Coverage (COBRA)

Employee

  • Your hours of employment are reduced below the number of hours required to be eligible for the employer contribution toward health care coverage.
  • You become entitled to benefits under Medicare.
  • Your employment ends for any reason other than gross misconduct.

Spouse

  • Your spouse (the employee) dies, and you don’t qualify for PEBB retiree insurance coverage as a surviving spouse.
  • Your spouse’s (the employee’s) hours of employment are reduced.
  • Your spouse’s (the employee’s) employment ends for any reason other than for gross misconduct.
  • You and your spouse divorce. If your spouse (the employee) reduces or cancels (terminates) your SEBB health plan coverage in anticipation of a divorce, the divorce may be considered a qualifying event even though you lost coverage before the divorce was final.

State-registered domestic partner

  • Your state-registered domestic partner (the employee) dies, and you don’t qualify for PEBB retiree insurance coverage as a surviving dependent
  • Your state-registered domestic partner’s (the employee’s) hours of employment are reduced.
  • Your state-registered domestic partner’s (the employee’s) employment ends for any reason other than gross misconduct.
  • Your state-registered domestic partnership (with the employee) is terminated. If your state-registered domestic partner (the employee) reduces or terminates your SEBB health plan coverage in anticipation of the termination, the termination may be considered a qualifying event even though you lost coverage before the legal termination of the state-registered domestic partnership was final.

Dependent children

  • Your parent (the employee) dies, and you don’t qualify for PEBB retiree insurance coverage as a surviving dependent.
  • Your parent's (the employee’s) hours of employment are reduced.
  • Your parent's (the employee’s) employment ends for any reason other than gross misconduct.
  • Your eligibility for SEBB coverage as a dependent child ends.

State-registered domestic partner's child

  • Your parent’s state-registered domestic partner (the employee) dies, and you don’t qualify for PEBB retiree insurance coverage as a surviving dependent.
  • Your parent’s state-registered domestic partner’s (the employee’s) hours of employment are reduced.
  • Your parent’s state-registered domestic partner’s (the employee’s) employment ends for any reason other than gross misconduct.
  • Your eligibility for SEBB health plan coverage as a dependent child ends.

Children born to or placed for adoption with the covered employee during the SEBB Continuation Coverage (COBRA) coverage period

A child born to, adopted by, or placed for adoption with a covered employee during a period of SEBB Continuation Coverage (COBRA) is considered a qualified beneficiary under federal COBRA rules. The child may be enrolled in SEBB Continuation Coverage (COBRA) due to a special open enrollment event or during the SEBB Program’s annual open enrollment period. Coverage can last for the duration of the SEBB Continuation Coverage (COBRA) coverage period, measured from the original qualifying event date. To be enrolled in SEBB health coverage, the child must otherwise satisfy SEBB eligibility requirements.

Alternate recipients under National Medical Support Notice (NMSN) or court order

A child of the covered employee who is receiving benefits pursuant to a NMSN or court order, received by the employer or the SEBB during the covered employee’s period of employment, is entitled to the same rights to SEBB Continuation Coverage (COBRA) as an eligible dependent child of the covered employee.

Who is entitled to SEBB Continuation Coverage (Unpaid Leave)?

If you lose SEBB health plan coverage due to one of the events listed below, you are entitled to SEBB Continuation Coverage (Unpaid Leave).

Qualifying events for SEBB Continuation Coverage (Unpaid Leave)

  • You are on authorized leave without pay from your agency.
  • Your employment ends due to a layoff.
  • You are reverting to a position that is not eligible for the employer contribution toward insurance coverage.
  • You are appealing a grievance action.
  • You are receiving time-loss benefits under workers’ compensation.
  • You are applying for disability retirement.
  • You are called to active duty in the uniformed services, as defined under the Uniformed Services Employment and Reemployment Rights Act (USERRA).

What is a qualified beneficiary?

A qualified beneficiary is an employee, spouse, or their dependent child who lost SEBB health plan coverage due to a qualifying event and is entitled to continue their SEBB Continuation Coverage under federal COBRA rules. State-registered domestic partners and their children who lost SEBB health coverage due to the same types of events may choose SEBB Continuation Coverage (COBRA), under Washington State law (RCW 26.60.015 and SEBB policy resolution, under the same terms and conditions as spouses and other eligible dependents under federal COBRA rules. When the SEBB Program uses the term "qualified beneficiary" it also applies to state-registered domestic partners and their children who lost SEBB health coverage due to the same types of events. Exception: You must be an employee, spouse, or qualified tax dependent (as defined in IRC §152(c)(2)) to be eligible to continue a Medical Flexible Spending Arrangement (FSA).

What if I decline SEBB Continuation Coverage?

If you reject or decline SEBB Continuation Coverage before the due date, you may change your mind as long as the SEBB Program receives your completed election form(s) no later than 60 days from the date your SEBB health plan coverage ended, or from the postmark date on the SEBB Continuation Coverage Election Notice, whichever is later.