Employee and retiree benefits

File an appeal: SEBB

Find out how you can appeal a decision or denial by your employer or the School Employees Benefits Board (SEBB) Program.

Who can appeal?

If you are a subscriber, dependent, or applicant for SEBB Program benefits, you may be able to file an appeal of a decision made by your employer or the SEBB Program. The rules for filing an appeal are in chapter 182-32 WAC.

If you want to appeal a decision by a SEBB Program health plan, insurance carrier, or benefit administrator, see How can I appeal a decision made by a plan? For example, you would contact your health plan to appeal a denial of a medical claim.

How can I appeal a decision?

If you or your dependent disagrees with a specific decision or denial, you or your dependent may file an appeal. You can find guidance on filing an appeal in WAC 182-32.

If your situation is:

Follow these instructions and submission deadlines:

You disagree with a decision made by your employer and you are requesting your employer's review about:

  • Premium surcharges
  • Eligibility for or enrollment in:
    • Medical coverage
    • Dental coverage
    • Vision coverage
    • Life insurance
    • Long-term disability insurance
    • Medical Flexible Spending Arrangement (FSA)
    • Dependent Care Assistance Program (DCAP)

Instructions: Submit the School Employee Request for Review/Notice of Appeal form to your employer.

Deadline: Your employer must receive the form no later than 30 calendar days after the date of the initial denial notice or decision you are appealing.

You disagree with a review decision made by your employer, or agree that further review is needed because your employer did not grant you the relief you requested, and are now requesting review of your employer’s decision.

Instructions: Submit the School Employee Request for Review/Notice of Appeal form to the SEBB Appeals Unit as directed on the form, or follow the appeal rules as outlined in WAC 182-32-2070.

Deadline: The SEBB Appeals Unit must receive the form no later than 30 calendar days after the date of your employer's review decision.

Address
Health Care Authority
Attn: SEBB Appeals Unit
PO Box 45504
Olympia, WA 98504

Your appeal concerns a decision from the SEBB Program about:

  • Eligibility for or enrollment in:
    • Premium payment plan
    • Medical Flexible Spending Arrangement (FSA)
    • Dependent Care Assistance Program (DCAP)
    • Life insurance
  • Eligibility to participate in SmartHealth or receive a wellness incentive
  • Dependent, extended dependent, or disabled dependent eligibility
  • Premium surcharges
  • Premium payments

Instructions: Submit the School Employee Request for Review/Notice of Appeal form to the SEBB Appeals Unit as directed on the form, or follow the appeal rules as outlined in WAC 182-32-2070.

Deadline: The SEBB Appeals Unit must receive the form no later than 30 calendar days after the date of the denial notice or decision you are appealing.

Address
Health Care Authority
Attn: SEBB Appeals Unit
PO Box 45504
Olympia, WA 98504

If you applied for PEBB retiree insurance coverage and were denied, and you wish to appeal the denial, please see the PEBB retiree appeals page.

How do I appeal a decision made by a plan?

If you are seeking a review of a decision made by a SEBB Program health plan, insurance carrier, or benefit administrator, contact the plan to request information on how to appeal its decision. For example, you would contact your health plan to appeal a denial of a medical claim.

How do I appeal a decision made by a presiding officer?

You can appeal the SEBB Appeals Unit’s Presiding Officer’s Initial Order by filing a written request for review or by making an oral request for review. Information detailing your right to request review is included in the SEBB Appeal Unit’s Presiding Officer’s Initial Order. Once your request for review is received by the Appeals Unit, a final order will generally be mailed within 20 days.

If you have additional documents you think will help your case that you have not previously submitted, you may send them with your Request for Review. The Review Officers will consider them along with the documents from the Brief Adjudicative Proceeding. Information received after your Request for Review will not be considered.

Mail to:
Health Care Authority
Attn: SEBB Appeals Unit
PO Box 45504
Olympia, WA 98504-5504

Fax: 360-586-9080

Request an oral review by calling 1-800-351-6827.

Deadline: The SEBB Appeals Unit must receive your Request for Review no later than 21 calendar days after the service date of the initial order.

What is a formal hearing?

Under certain circumstances a presiding officer or review officer may determine that a hearing is necessary to make a decision. When this happens the appellant will receive an order converting their appeal. Shortly after the conversion, the appellant should receive an order describing when the formal hearing will take place. For more information see WAC 182-32-3000.

Can I have someone represent me in this appeal?

You may choose to be represented by another person, except employees of the Health Care Authority (HCA) or HCA’s authorized agents. This can include a non-attorney representative or an attorney that you personally hire to represent you. If you hire an attorney to represent you, the attorney must file a written notice of appearance. Both a non-attorney representative and a licensed attorney must provide the SEBB Appeals Unit with a written consent signed by you, permitting release of the relevant protected health information to the representative of your choosing. 

Contact

SEBB Appeals unit
Phone:
1-800-351-6827
FAX: 360-725-0771

Mailing address:
Health Care Authority
Attn: SEBB Appeals Unit
PO Box 45504
Olympia, WA 98504-2699

The SEBB Program