How to enroll

How do I elect continuation coverage?

To elect SEBB Continuation Coverage, the SEBB Program must receive your completed form(s) no later than 60 days after December 31, 2019, (when health plan or 2019 COBRA coverage ends) or from the postmark date on the SEBB Continuation Coverage Election Notice, whichever is later.

Oral communications (in person or by telephone) and electronic communications (fax or email) are not acceptable methods of making an election and will not preserve your continuation coverage rights. If the SEBB Program does not receive your completed form(s) by the required 60-day deadline, your SEBB coverage will end on the last day of the month following the date of the qualifying event.

Who must provide notice when I lose eligibility for SEBB insurance coverage?

Your employer must notify the SEBB Program when:

  • Your (the employee’s) employment ends.
  • Your (the employee’s) hours of employment are reduced.
  • You (the employee) die.

You, your dependents, or a representative acting on your behalf must provide written notice to your employer's payroll, or benefits office (if you're an employee) when:

  • You divorce or terminate a state-registered domestic partnership.
  • Your child loses eligibility (dependent status) under SEBB rules.

Your dependents or a representative acting on your behalf must notify the SEBB Program either in writing or by phone when you (the employee) die.

Deadline to provide written notice

You, your dependents, or your representative must provide written notice to your payroll or benefits office (if you’re an employee) no later than 60 days after the following, whichever occurs later:

  1. The date of the qualifying event, or
  2. The date you or a covered dependent loses (or would lose) eligibility for SEBB coverage due to a qualifying event.

Example 1: If you and your spouse divorce on June 15, the qualifying event date is June 15. Your former spouse loses eligibility for SEBB benefits on the last day of the month in which the divorce occurred (June 30). The SEBB Program must receive written notice of the qualifying event no later than 60 days after the qualifying event date or the date eligibility ends, whichever occurs later. In this case, eligibility for SEBB coverage ends on June 30, after the qualifying event date (June 15). Therefore, your employer or the SEBB Program must receive written notice no later than 60 days after June 30.

Example 2: You cancel (terminate) coverage for your spouse on December 31 in anticipation of a divorce, but your divorce is not final until June 15. The SEBB Program must receive written notice of the qualifying event no later than 60 days after the qualifying event date (June 15) or the date SEBB coverage ends (December 31). In this case, the qualifying event date occurs June 15, after SEBB coverage ends. Therefore, your employer or the SEBB Program must receive written notice no later than 60 days after June 15.

Once your employer or the SEBB Program is notified of the qualifying event, a SEBB Continuation Coverage Election Notice will be mailed to the address you provide.

What information is needed to provide notice of a qualifying event?

Any written notice you, your dependent, or your representative provides must include:

  1. The name and address of the employee who is (or was) covered.
  2. The name, address, telephone number, and signature of the person providing the notice.
  3. The names and addresses of all qualified beneficiaries who lost coverage as a result of the qualifying event.
  4. The qualifying event and the date it happened.

And

If providing written notice of a divorce or termination of state-registered domestic partnership: In addition to items 1–4 above, include proof of the divorce or termination of state-registered domestic partnership. If you notify the SEBB Program that your coverage was reduced or canceled (terminated) in anticipation of a divorce or termination of a state-registered domestic partnership, your notice must include proof that your coverage was reduced or canceled (terminated).

And

If providing written notice of a disability (or that a disability has ended), your notice must include items 1–4 above and:

  • The name and address of the disabled qualified beneficiary.
  • The date the qualified beneficiary became disabled.
  • The names and addresses of all qualified beneficiaries who are receiving continuation coverage.
  • A copy of the Social Security Administration's letter showing the disability determination date or a statement from the Social Security Administration that the qualified beneficiary is no longer disabled.

If providing written notice of a second qualifying event, your notice must include items 1–4 above and:

  • The second qualifying event and the date it happened.
  • The names and addresses of all qualified beneficiaries who are receiving continuation coverage.
  • Proof of the second qualifying event.

How long does continuation coverage last?

SEBB Continuation Coverage provides temporary health plan coverage. Maximum coverage periods can last anywhere from 18 to 36 months and are based on the qualifying event that caused you or your covered dependent to lose SEBB health plan coverage. A table listing the maximum coverage periods based on the qualifying events is below.

Coverage can end before the maximum coverage period if:

  • Automatically canceled (terminated) because any required premiums and any applicable premium surcharges are not paid on time or the employer stops providing any group health plan for its employees.
  • Automatically canceled (terminated) under federal COBRA rules because you become entitled to Medicare after you enroll or you enroll under other group health plan coverage.
  • A qualified beneficiary stops being disabled.
  • You ask to cancel (terminate) coverage.

For details consult the SEBB Continuation Coverage Election Notice.

Qualifying event
(reason that you or your covered dependent lost SEBB coverage)

Eligible member

Maximum continuation coverage period 

Termination of employment (other than for gross misconduct) or reduction of hours

  • Employee
  • Spouse
  • State-registered domestic partner
  • Children

18 months1

Additional months of coverage may be available under SEBB Continuation Coverage (Unpaid Leave).

Entitled to Medicare within 18 months before termination of employment or reduction of hours

  • Spouse
  • State-registered domestic partner
  • Children
Up to 36 months, measured from the date of the employee's Medicare entitlement.
  • Authorized leave without pay
  • Employment ends due to a layoff
  • Receiving time-loss benefits under workers' compensation
  • Applying for disability retirement
  • Called to active military duty, as defined by the Uniformed Services Employment and Reemployment Rights Act (USERRA)
  • Approved educational leave

Employee

Employee must enroll to cover dependents. Dependents do not have independent election rights under SEBB Continuation Coverage (Unpaid Leave).

29 months

An employee who is no longer eligible for SEBB Continuation Coverage (Unpaid Leave), but who has not used the maximum number of months allowed under COBRA, may continue medical, dental, vision, or a combination of these benefits for the remaining difference in months allowed under COBRA (see WAC 182-31-100(2)).

Appealing a  grievance action

Employee

Employee must enroll to cover dependents. Dependents do not have independent election rights under SEBB Continuation Coverage (Unpaid Leave).

29 months

If the dismissal is upheld and the employee has not used the maximum number of months allowed under COBRA, they may continue medical, dental, vision, or a combination of these benefits for the remaining difference in months allowed under COBRA.

Death of an employee2
  • Spouse
  • State-registered domestic partner
  • Children

36 months (from the date employer-based coverage ended)

PEBB retiree insurance coverage may also be available in certain cases.

Divorce or termination of a state-registered domestic partnership
  • Spouse
  • State-registered domestic partner
  • Step-children
36 months (from the date coverage ended)
Child loses eligibility under SEBB rules
  • Children
36 months

In certain circumstances, qualified beneficiaries entitled to 18 months of SEBB Continuation Coverage (COBRA) may become entitled to a disability extension of an additional 11 months (for a total maximum of 29 months) or an extension of an additional 18 months due to the occurrence of a second qualifying event (for a total maximum of 36 months) as described under When can continuation coverage be extended?

2 If the qualifying event is the death of an employee (see WAC 182-31-130 and WAC 182-12-265), surviving dependents may be eligible for PEBB retiree insurance coverage. Under PEBB retiree insurance coverage, the spouse or state-registered domestic partner may continue coverage until their death, and children may continue coverage until they lose eligibility for PEBB benefits according to WAC 182-12-260.

When can continuation coverage be extended?

If you or your qualified beneficiaries* are enrolled in SEBB Continuation Coverage (COBRA) for 18 months due to the employee’s termination of employment or reduction of hours, there are two ways in which this 18-month period of continuation coverage can be extended:

  1. When you or a qualified beneficiary is determined disabled by the Social Security Administration.
  2. When a second qualifying event occurs.

A Medical Flexible Spending Arrangement (FSA) may only be continued through the year in which the original qualifying event occurred. Therefore, the extension of coverage rule does not apply to Medical FSAs, and they cannot be extended under any circumstances.

Disability extension of coverage

If the Social Security Administration determines that any qualified beneficiary* is disabled, you and all of the qualified beneficiaries in your family may be entitled to receive up to 11 months of additional continuation coverage (for a total of 29 months). This extension is available only to those individuals who are receiving continuation coverage because of the covered employee’s termination of employment or reduction of hours.

The disability must have started at any time during the first 60 days of SEBB Continuation Coverage (COBRA), and must last at least until the end of the 18-month SEBB Continuation Coverage (COBRA) period.

The disability extension is available only if you notify the SEBB Program in writing and submit a SEBB Continuation Coverage (COBRA) Election/Change form and a copy of the disability award letter from the Social Security Administration no later than 60 days after the last of the following events:

  • The date of the Social Security Administration’s disability determination.
  • The date of the covered employee’s termination of employment or reduction of hours.
  • The date the qualified beneficiary loses (or would lose) coverage under SEBB rules as a result of the covered employee’s termination of employment or reduction of hours.
  • The date the SEBB Program mails a SEBB Continuation Coverage Election Notice to the qualified beneficiary, informing the beneficiary of their responsibility and the procedures to notify the SEBB Program.

You must also provide this notice before the end of the initial 18 months of SEBB Continuation Coverage (COBRA) to be entitled to a disability extension. If the notice procedures in the SEBB Initial Notice of COBRA and Continuation Coverage Rights are not followed or if the notice is not submitted to the SEBB Program during the 60-day notice period and before the end of the initial 18 months of SEBB Continuation Coverage (COBRA), then there will be no disability extension of SEBB Continuation of Coverage (COBRA).

The right to the disability extension may be terminated if the Social Security Administration determines that the disabled qualified beneficiary is no longer disabled. You or your qualified beneficiaries have 30 days after the Social Security Administration’s determination to notify the SEBB Program when a qualified beneficiary is no longer disabled.

Second qualifying event extension of coverage

If your qualified beneficiary* experiences a second qualifying event while receiving 18 months of continuation coverage (or 29 months, if the second event occurs during the disability extension), they may be entitled to receive up to an additional 18 months of continuation coverage, for a maximum of 36 months of continuation coverage.

To qualify for a second qualifying event extension of coverage, the second event must:

  • Occur during the initial SEBB Continuation Coverage (COBRA) period resulting from termination of employment, reduction of hours, or the retiree’s loss of SEBB retiree insurance coverage due to termination of employer group participation with SEBB insurance coverage; and
  • Cause a qualified beneficiary* to lose coverage under SEBB Program rules if the first qualifying event had not occurred. This includes:
    • The employee’s death.
    • Divorce.
    • Termination of a state-registered domestic partnership.
    • The dependent child loses eligibility for coverage under the SEBB Program rules.

Note: The second qualifying event extension is not available when an employee becomes entitled to Medicare after their termination of employment or reduction of hours. However, the employee and covered dependents that are not entitled to Medicare may remain enrolled in COBRA for the duration of the SEBB Continuation Coverage (COBRA) period.

Eligible dependents must have been covered under the plan on the day before the first qualifying event. Newborns or adopted children added after the first qualifying event are also eligible for the second qualifying event extension.

To request a second qualifying event extension, you or your qualified beneficiary must provide notice of the qualifying event to the SEBB Program in writing and provide information as noted in What information is needed to provide notice of a qualifying event no later than 60 days after the last of the following events:

  • The date of the second qualifying event.
  • The date the qualified beneficiary would lose coverage under SEBB Program rules as a result of the second qualifying event.
  • The date the SEBB Program mails a SEBB Continuation Coverage Election Notice to the qualified beneficiary, informing the beneficiary of their responsibility and the procedures to notify the SEBB Program.

*State-registered domestic partners and their children who lost coverage due to a qualifying event as described under Who is entitled to SEBB Continuation Coverage are allowed to extend the period of continuation coverage in the same situations as a spouse or child who is a qualified beneficiary.