If you are displaced or affected by wildfire, all Washington Apple Health and PEBB/SEBB medical plans are allowing prescription refills before the refill date.
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Change your coverage
Learn the requirements to make changes to your SEBB coverage.
On this page
Before you make a change, it is important to:
- Make sure the health plan is available in your area.
- Check the plan's provider directory or contact your plan to make sure your provider is in the plan's network.
- Compare monthly plan costs (premiums).
- Compare benefits and your costs for care (deductibles, coinsurance, and/or copays).
You can make changes to your enrollment or health plan elections in one of these ways.
To make a change during the annual open enrollment
- Log in to SEBB My Account and change your selections.
- Submit the required form(s) to your payroll or benefits office during the open enrollment period.
To make a change when a special open enrollment event occurs
- Log in to SEBB My Account or submit the required form(s) to your payroll or benefits office when a special open enrollment even occurs, within the SEBB Program's timelines.
You can make some changes outside of annual open enrollment without a special open enrollment event.
- Change your name and/or address by notifying your payroll or benefits office. You cannot change this through SEBB My Account.
- Make changes to your tobacco use premium surcharge attestation. You can do this in SEBB My Account or use the 2020 SEBB Premium Surcharge Attestation Change form.
- Apply for, cancel, change coverage amounts, and update beneficiary information for supplemental life and accidental death and dismemberment (AD&D) insurance.
- Remove dependents from coverage due to loss of eligibility (this is required). You must make this change in SEBB My Account or submit the completed 2020 School Employee Change Form to your payroll or benefits office no later than 60 days after the event. You may also need to provide proof of the event before the dependent can removed.
- Enroll in or cancel supplemental long-term disability insurance. You can do this in SEBB My Account or with the Long-Term Disability Enrollment/Change form.
- Start, stop, or change your contribution to your Health Savings Account (HSA). Log in to SEBB My Account or use the Employee Authorization for Payroll Deduction to Health Savings Account form.
- Change your HSA beneficiary information. Use the Health Savings Beneficiary Designation form.
- You can only change medical, dental, or vision plans during the SEBB Program's annual open enrollment or if a special open enrollment event occurs.
- All eligible dependents must enroll in the same health plan. (Dependents can have different providers.)
- If you have a provider you want to stay with, contact the new plan or check the plan’s provider directory to make sure your provider is in that plan’s network.
- You may be enrolled in only one SEBB medical, dental, or vision plan. If you and your spouse or state-registered domestic partner are both eligible subscribers, you need to choose which of you will cover yourselves and your eligible children (including adult children who are also eligible for SEBB coverage as an employee). Enrolled dependents will be listed on one account, not both. However, you must enroll in dental, vision, basic life and AD&D insurance, and basic LTD insurance under your own account.
During the annual open enrollment you can:
- Change your medical, dental, and vision plans.
- Enroll your eligible dependents.
- Waive medical coverage.
- Enroll in a Medical Flexible Spending Arrangement (FSA).
- Enroll in the Dependent Care Assistance Program (DCAP).
- Attest to the spouse or state-registered domestic partner coverage premium surcharge.
Certain events let you make account changes (like changing plans or enrolling a dependent) outside of annual open enrollment. A special open enrollment event must be an event other than an employee gaining initial eligibility for SEBB benefits.
You must provide proof of the event that created the special open enrollment (for example, a marriage or birth certificate) along with the required enrollment/change forms to your payroll or benefits office, or in SEBB My Account, no later than 60 days after the event. For more information please see SEBB Administrative Policy 45-2 and Addendum 45-2A.
In many instances, the date your change is received affects the effective date of the change in enrollment. If a school employee wants to enroll a newborn or child whom the school employee has adopted or has assumed a legal obligation for total or partial support in anticipation of adoption, the school employee should notify their SEBB organization by submitting an enrollment form as soon as possible to ensure timely payment of claims. If adding the child increases the premium, the required enrollment/change form must be received no later than sixty days after the date of the birth, adoption, or the date the legal obligation is assumed for total or partial support in anticipation of adoption. School employees should contact their payroll, or benefits office for the required forms.
These changes may be allowed as a special open enrollment:
If this event happens
|Add dependent||Remove dependent||Change SEBB medical, dental and/or vision plan||Waive medical coverage||Enroll after waiving SEBB medical coverage|
Marriage, registering a domestic partner, birth, adoption, or assuming a legal obligation for total or partial support in anticipation of adoption
Child becomes eligible as an extended dependent through legal custody or legal guardianship
|Employee or dependent loses eligibility for other coverage under a group health plan or through health insurance, as defined by the Health Insurance Portability and Accountability Act (HIPAA)||Yes||No||Yes||No||Yes|
|Employee has a change in employment status that affects the employee's eligibility for their employer contribution toward their employer-based group health plan||Yes||Yes||Yes||Yes||Yes|
|Employee's dependent has a change in their employment status that affects their eligibility for the employer contribution under their employer-based group health plan||Yes||Yes||Yes||Yes||Yes|
|Employee has a change in employment from a SEBB organization to a public school district that straddles county lines or is in a county that boarders Idaho or Oregon, which results in having different medical plans available.||No||No||Yes||No||No|
|Employee or dependent has a change in enrollment under another employer-based group health plan during its annual open enrollment that does not align with the SEBB Program’s annual open enrollment.||Yes||Yes||No||Yes||Yes|
|Employee's dependent moves from outside the United States to live within the United States, or from within the United States to live outside of the United States, and that change in residence results in the dependent losing their health insurance.||Yes||Yes||No||No||Yes|
|Employee or dependent has a change in residence that affects health plan availability.||No||No||Yes||No||No|
|A court order requires the employee or any other individual to provide a health plan for an eligible child of the employee.||Yes||Yes||Yes||No||Yes|
|Employee or dependent becomes entitled to or loses eligibility for Apple Health (Medicaid) or a state Children’s Health Insurance Program (CHIP).||Yes||Yes||Yes||Yes||Yes|
|Employee or a dependent becomes eligible for a state premium assistance subsidy for SEBB health plan from Apple Health (Medicaid) or a state CHIP.||Yes||No||Yes||No||Yes|
|Employee or an employee's dependent becomes entitled to coverage under Medicare, or the employee or employee's dependent loses eligibility for coverage under Medicare.||No||No||Yes||Yes||Yes|
|Employee's or dependent’s current health plan becomes unavailable because the employee or dependent is no longer eligible for a Health Savings Account (HSA).||No||No||Yes||No||No|
|Employee or dependent experiences a disruption of care that could function as a reduction in benefits for the employee or their dependent for a specific condition or ongoing course of treatment (requires approval by the SEBB Program).||No||No||Yes, if approved by SEBB||No||No|
|Employee or dependent becomes eligible and enrolls in a TRICARE plan, or loses eligibility for a TRICARE plan.||No||No||No||Yes||Yes|
1 Subscriber may add only the new spouse, state-registered domestic partner, or children of the spouse or partner. Existing dependents may not be added.
2 Subscriber may only remove a dependent from SEBB coverage if the dependent enrolls in the new spouse's or state-registered domestic partner's plan.
Your SEBB benefits end the last day of the school year (August 31). Your benefits will end earlier if:
- Your employer terminates your employment. Eligibility and coverage end the last day of the month in which the termination notice is effective.
- You resign. Eligibility and coverage ends the last day of the month in which your resignation is effective.
- Your work pattern or schedule is reduced and your employer no longer anticipates you will work 630 compensated hours during the school year. Coverage ends the last day of the month in which the change is effective.
If you have dependents currently on continuation coverage through your SEBB organization on December 31, 2019, who are not eligible as dependents under the SEBB Program, continuation coverage options may be available. You may choose to self-pay to continue their coverage for up to 18 months.
After eligibility for employer-paid coverage ends, you, your dependents, or both may be able to temporarily continue your SEBB insurance coverage by self-paying the premiums and applicable premium surcharges on a posttax basis with no contribution from your employer. You can also enroll on your spouse’s or state-registered domestic partner’s employer-paid SEBB coverage as a dependent. Options for continuing coverage vary based on the reason eligibility is lost.
The SEBB Program will mail a SEBB Continuation Coverage Election Notice booklet to you or your dependent at the address we have on file when your employer-paid coverage ends. This booklet explains the coverage options and includes enrollment forms to apply for continuation coverage.
You or your eligible dependents must submit the appropriate election form to the SEBB Program no later than 60 days from the date SEBB health plan coverage ended or from the postmark date on the SEBB Continuation Coverage Election Notice, whichever is later. If the election notice is not received by the deadline, you will lose all rights to continue SEBB insurance coverage.
There are three possible continuation coverage options you and your eligible dependents may qualify for:
- SEBB Continuation Coverage (COBRA)
- SEBB Continuation Coverage (Unpaid Leave)
- PEBB retiree insurance coverage