Employer groups

Eligibility

Tribal schools and employee organizations representing school employees are eligible to purchase employee benefits through the School Employees Benefits Board (SEBB) Program per chapter 41.05 RCW and WAC 182-30-5000.

SEBB Program group coverage is available only to entities and employees that perform governmental functions and are not controlled by private interests. SEBB Program group coverage is available to all employees, individual bargaining groups, or all nonrepresented employees of the group.

Your group may request inclusion of retirees covered under your current retiree health plan, subject to the SEBB Program requirements outlined in WAC 182-30-5000. School employees who retire after your group joins SEBB will be eligible for Public Employees Benefits Board (PEBB) Program retiree insurance coverage based on retiree eligibility rules. Coverage for retirees only is not available to employer groups.

Eligibility criteria for school employees are defined in WAC 182-31-040 and for dependents in WAC 182-31-140. The employer group may negotiate different eligibility criteria with HCA for their employees as described in RCW 41.05.740(6)(d). Requests must be submitted in writing and approved by HCA.

Participating employer groups will incur an employer group rate surcharge that will be applied to the monthly rate. For more information about the employer group rate surcharge call SEBB Outreach and Training at 1-800-700-1555.

Benefits

The SEBB Program provides a comprehensive insurance package that includes:

• Medical
• Dental
• Vision
• Life and accidental death and dismemberment (AD&D) insurance
• Long-term disability insurance

Employer groups may purchase only medical coverage or the full benefits package of medical, dental, vision, life, AD&D, and long-term disability insurance.

Costs

View the employer groups monthly premiums. Premiums for employer groups change in January.

Use the Employer Group 2024 Projected Monthly Cost Tool to estimate SEBB Program rates based on subscriber enrollment selections.

Startup fees

When a group joins the SEBB Program, they are assessed a start-up fee based on the number of eligible employees. The following table outlines these start-up fees.

How to apply

The application requirements for employer groups vary, depending upon the number of employees in the group.

• Groups with fewer than 500 employees must submit a complete application at least 60 days before the requested coverage effective date.
• Groups with 500 or more employees but fewer than 5,000 employees must submit a complete application at least 90 days before the requested coverage effective date.
• Groups with 5,000 or more employees must submit a complete application at least 120 days before the requested coverage effective date.

Deadlines

• Application submission deadlines.

All groups must provide the following:

1. A letter of application that includes:
   • A reference to the group's authorizing statute;
   • A description of the organizational structure and a description of the employee bargaining unit or group of nonrepresented employees for which the group is applying;
   • Tax ID number; and
   • A statement of whether the group is requesting medical, dental, vision, life, AD&D, and long-term disability insurance or medical only.
2. A resolution from the group's governing body authorizing the purchase of SEBB insurance coverage. Sample resolution.
3. A signed governmental function attestation that attests to the fact that employees for whom the group is applying are governmental employees whose services are substantially all in the performance of essential governmental functions. Sample attestation.
4. A Member Level Census Data file for all employees for whom the group is applying. The file must be provided in the format required and contain the following: demographic data, by member, with each member classified as employee, spouse or state-registered domestic partner, or child. If the application is for a subset of the group’s employees (e.g., bargaining unit), the group must provide a Member Level Census Data file for all employees eligible under the current health plans who are not included in the census file above. This includes retired employees participating under the group’s current health plans.
5. Historical claims and cost information that includes:
   • Large claims history for 24 months by quarter that excludes the most recent 3 months,
   • Ongoing large claims management report for the most recent quarter provided in the large claims history, and
   • A summary of historical plan costs.

In addition, groups with 5,000 or more employees and employee organizations representing school employees, regardless of the number of employees, must also provide the following:

1. An actuarial evaluation of the group provided by an actuary designated by the SEBB Program. The group must pay for the cost of the evaluation.
2. An executive summary of benefits, a summary of benefits and certificate of coverage.

For additional information, call SEBB Outreach and Training at 1-800-700-1555.

Send your application to:

Jesse Paulsboe
SEBB Program Outreach and Training
Health Care Authority
PO Box 42684
Olympia, WA 98504-2684
Email: Jesse Paulsboe

Review process

HCA will review your application for compliance with HCA terms and conditions of participation. Groups with fewer than 5,000 employees will be notified by the SEBB Program in writing upon acceptance or denial of your application. Your application may be denied if your group fails to provide the required information and documents described here.

Groups with 5,000 employees or more and employee organizations representing school employees, regardless of the number of employees, will have their application approved or denied through the evaluation criteria described in WAC 182-30-5000.

You will be notified by the SEBB Program in writing upon acceptance or denial of your application. If the application is denied, you may reapply for participation at any time. In addition, you may file an appeal.

What to do when your group is enrolled

The SEBB Program bills groups monthly. You will receive an invoice around the 15th of each month before the month of coverage. Payment in full is due by the 5th of the month following the month of coverage. For example, around May 15 an invoice will be sent for June coverage. Payment in full for June coverage is due by July 5.

You are expected to provide your own SEBB Program account maintenance. Groups must manage entering account information into the SEBB Program insurance system. The SEBB Program provides training.

Cancelling participation