HCA’s lobby is now open for walk-in customer service. Learn about customer service options.

Special open enrollment

Some life events (marriage, birth of a child, etc.) qualify you to make changes to your benefits outside of our annual open enrollment. We call these events and the time period you have to make changes (60 days) a "special open enrollment."

What changes can I make? 

Based on the event, the following changes may be allowed as a special open enrollment. 

As defined by Washington Administrative Code 182-31-020.

Action

Allowed?

Add dependent

Yes

Change medical plan

Yes
(A health plan change is not allowed when adding a SRDP or their child if they are not a tax dependent.)

Change dental/vision plan Yes
(A health plan change is not allowed when adding a SRDP or their child if they are not a tax dependent.)

Documents to submit

  • Marriage certificate.
  • Certificate of state-registered domestic partnership or legal union and the SEBB Declaration of Tax Status.
  • Also provide evidence the marriage/partnership is still valid (e.g., a utility bill or bank statement) dated within the past six months showing both names.

If the marriage or state-registered domestic partnership is within six months, only a marriage certificate or certificate of state-registered domestic partnership or legal union is required.

 Birth, adoption, or assuming a legal obligation for support in anticipation of adoption.  

You must also submit a SEBB Declaration of Tax Status if adding a state-registered domestic partner or their child to indicate whether they qualify as a dependent for tax purposes under IRC Section 152, as modified by IRC Section 105(b). 

Action

Allowed?

Add dependent

Yes

Change medical plan

Yes

Change dental/vision plan Yes

Documents to submit

  • Birth certificate (or hospital certificate with child’s footprints).
  • Certificate or decree of adoption.
  • Placement letter from adoption agency.
  • SEBB Declaration of Tax Status if adding child of a state-registered domestic partner.

All valid documents for proof of this event must show the name of the parent who is the subscriber, subscriber’s spouse, or the subscriber’s state-registered domestic partner.

Child becomes eligible as an extended dependent through legal custody or legal guardianship.

Also Submit a SEBB Extended Dependent Certification and SEBB Declaration of Tax Status to indicate whether they qualify as a dependent for tax purposes under IRC Section 152, as modified by IRC Section 105(b).

Action

Allowed?

Add dependent

Yes

Change medical plan

Yes

Change dental/vision plan Yes

​Documents to submit

 

Subscriber or dependent loses other coverage under a group health plan or through health insurance, as defined by the Health Insurance Portability and Accountability Act (HIPAA). 

Action

Allowed?

Add dependent

Yes

Change medical plan

Yes

Change dental/vision plan Yes

Documents to submit

  • Certificate of creditable coverage.
  • Letter of termination of coverage from health plan or payroll or benefits office.
  • COBRA election notice.

Subscriber has a change in employment status that affects the subscriber’s or dependent’s eligibility for the employer contribution toward their employer-based group health plan. 

Action

Allowed?

Add dependent

Yes

Change medical plan

Yes

Change dental/vision plan Yes

Documents to submit

  • Employee hire letter from employer that contains information about benefits eligibility.
  • Employment contract.
  • Termination letter.
  • Letter of resignation.
  • Statement of insurance.
  • Certificate of coverage.

 Subscriber or dependent has a change in enrollment under another employer-based group health insurance plan during its annual open enrollment that does not align with the SEBB Program’s annual open enrollment.

Action

Allowed?

Add dependent

Yes

Change medical plan

No

Change dental/vision plan No

Documents to submit

  • Employee hire letter from their employer that contains information about benefits eligibility.
  • Employment contract.
  • Termination letter.
  • Letter of resignation.
  • Statement of insurance.
  • Certificate of coverage.

 Subscriber’s dependent moves from another country to within the United States, or from the United States to another country, and that change in residence resulted in the dependent losing their health insurance.

Action

Allowed?

Add dependent

Yes

Change medical plan

No

Change dental/vision plan Yes

Documents to submit

  • Visa or passport with date of entry
  • Proof of former and current residence (e.g. utility bill)
  • Letter or document showing coverage was lost (e.g. certificate of credible coverage).

Subscriber or dependent has a change in residence that affects health plan availability. 

Action

Allowed?

Add dependent

No

Change medical plan

Yes

Change dental/vision plan Yes

Documents to submit

  • Proof of former and current residence (e.g. utility bill).
  • Certificate of credible coverage. 

 A court order requires the subscriber or any other individual to provide insurance coverage for an eligible child of the subscriber.

Action

Allowed?

Add dependent

Yes

Change medical plan

Yes

Change dental/vision plan Yes

Documents to submit

  •  Valid court order.

 Subscriber or dependent enrolls in or loses eligibility for, Medicaid or a Children’s Health Insurance Program (CHIP).

Action

Allowed?

Add dependent

Yes

Change medical plan

Yes

Change dental/vision plan Yes

Documents to submit

  • Enrollment or termination letter from Medicaid or CHIP reflecting the date the employee or employee's dependent enrolled in Medicaid or CHIP or the date at which they lost eligibility for Medicaid or CHIP.

Subscriber or a dependent becomes eligible for a state premium assistance subsidy for SEBB health plan coverage from Medicaid or a CHIP. 

Action

Allowed?

Add dependent

Yes

Change medical plan

Yes

Change dental/vision plan Yes

Documents to submit

  • Eligibility letter from Medicaid or CHIP.

 Subscriber or dependent enrolls in or loses eligibility for coverage under Medicare.

Action

Allowed?

Add dependent

Yes

Change medical plan

Yes

Change dental/vision plan No

Documents to submit

  • Medicare benefit verification letter.
  • Copy of Medicare card.
  • Notice of denial of Medicare coverage.
  • Social Security denial letter.
  • Medicare entitlement or cessation of disability form.

 Subscriber’s or dependent’s current health plan becomes unavailable because the subscriber or enrolled dependent is no longer eligible for a health savings account (HSA).

Action

Allowed?

Add dependent

No

Change medical plan

Yes

Change dental/vision plan Yes

Documents to submit

  • Cancellation letter from the health plan.
  • Coverage confirmation in a new health plan.
  • Medicare entitlement letter
  • Copy of current tax return claiming you as a dependent.

Subscriber or dependent experiences a disruption of care that could function as a reduction in benefits for the subscriber or their dependent for a specific condition or ongoing course of treatment (requires approval by the SEBB Program).

Action

Allowed?

Add dependent

No

Change medical plan

Yes

Change dental/vision plans Yes

Documents to submit

  • Submit request for a plan change to:
    Health Care Authority
    SEBB Program
    PO Box 42720
    Olympia, WA 98504-2720

 Subscriber has a change in employment from a SEBB organization to a school district that results in the employee having different medical plans available.

Action

Allowed?

Add dependent

No

Change medical plan

Yes

Change dental/vision plan Yes

Documents to submit

  • Employee hire letter from their employer that contains information about benefits eligibility.
  • Employment contract.

For more details about the changes you can make during these events, see SEBB Program Policy Addendum 45-2A, and refer to Washington Administrative Code (WAC): 

  •  182-30-090: When may a subscriber change health plans?
  • 182-31-150: When may subscribers enroll or remove eligible dependents?
  •  182-30-100: When may a school employee enroll, or revoke an election and make a new election under the premium payment plan, medical flexible spending arrangement (FSA), or dependent care assistance program (DCAP)?

How do I make changes? 

To take advantage of special open enrollments, your payroll or benefits office must receive the following forms and documentation no later than 60 days after the event.

(See SEBB Program Policy Addendum 45-2A for a list of valid documents.)

Things to know

  • When to submit. You may want to submit your request sooner to avoid a delay in the enrollment or change, and to ensure timely payment of claims.
  • Adding a child. When the special open enrollment is for birth, adoption, or assuming legal obligation for support ahead of adoption, submit the required forms and proof of your dependent’s eligibility and the event as soon as possible. If adding the child increases the premium, the PEBB Program must receive the required forms and proof no later than 60 days after the date of the birth, adoption, or when you assumed legal obligation.

Contact

The SEBB Program
Phone: 1-800-200-1004 
(TRS: 711)
Send us a secure message. You need to set up an account to protect your privacy and sensitive health information. By using our secure messaging system we can ensure that your data is safeguarded.