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Change your coverage

Learn the requirements to make changes to your SEBB coverage.

Before you make a change to your health plan

Before you make a change, it is important to:

How to make changes

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; or
  • Submit the required forms 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 forms to your payroll or benefits office within the SEBB Program's timelines, when a special open enrollment event occurs.

Changes you can make any time

You can make these changes outside of annual open enrollment without a special open enrollment event.

Plan change requirements

  • 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 that allows a health plan change.
  • 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 benefits as an employee). Enrolled dependents will be listed on one account, not both. However, if you waive enrollment in medical, you must enroll in dental, vision, basic life, basic AD&D insurance, and basic LTD insurance under your own account.

What changes can I make during the SEBB Program's annual open enrollment?

During the annual open enrollment you can:

  • Change your medical, dental, and vision plans.
  • Enroll or remove your eligible dependents.
  • Waive medical coverage.
  • Enroll in a medical plan, if you previously waived medical.
  • Enroll or reenroll in a Medical Flexible Spending Arrangement (FSA).
  • Enroll or reenroll in the Dependent Care Assistance Program (DCAP).
  • Attest to the spouse or state-registered domestic partner coverage premium surcharge.
  • Enroll or opt out of participation under the premium payment plan.

What is a special open enrollment?

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 Program Administrative Policy 45-2 and Addendum 45-2A.

In many instances, the date your form 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 SEBB medical coverage Enroll after waiving SEBB medical coverage Submit these documents (this list is not inclusive).

Marriage or registration of a domestic partner

Yes1

Yes2 Yes Yes3 Yes Marriage certificate, certificate of state-registered domestic partnership or legal union. Also provide evidence the marriage/partnership is still valid (e.g., a utility bill dated within the past six months showing both names)
Birth, adoption, or assuming a legal obligation for total or partial support in anticipation of adoption Yes Yes Yes Yes3 Yes Birth certificate (or hospital certificate with child’s footprints); certificate or decree of adoption; placement letter from adoption agency. 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

Yes No Yes No Yes Valid court order showing legal custody, guardianship, or temporary guardianship, signed by a judge or officer of the court and a signed SEBB Extended Dependent Certification form.
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 Certificate of creditable coverage; letter of termination of coverage from health plan or payroll or benefits office; COBRA election notice
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 hire letter from employer that contains information about benefits eligibility; employment contract; termination letter; letter of resignation; statement of insurance; certificate of coverage

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.

“Employer contribution” means contributions made by the dependent’s current or former employer toward health coverage as described in Treasury Regulation 54.9801-6.

Yes Yes Yes Yes Yes Employee hire letter from employer that contains information about benefits eligibility; employment contract; termination letter; letter of resignation; statement of insurance; certificate of coverage
Employee has a change in employment from a SEBB organization to a school district that results in having different medical plans available. No No Yes No No Employee hire letter from employer that contains information about benefits eligibility; employment contract
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 Yes3 Yes Certificate of credible coverage; letter of enrollment or termination of coverage from the health plan; letter of enrollment or termination of coverage from employer’s payroll or benefits office; proof of waiver
Employee's dependent moves from another country to live within the United States, or from within the U.S. to another country, and that change in residence results in the dependent losing their health insurance. Yes Yes No No Yes 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)
Employee or dependent has a change in residence that affects health plan availability. No No Yes No No Proof of former and current residence (e.g., utility bill); certificate of credible coverage
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 Valid court order
Employee or dependent enrolls in or loses eligibility for Apple Health (Medicaid) or a state Children’s Health Insurance Program (CHIP). Yes Yes Yes No Yes Enrollment or termination letter from Medicaid or CHIP reflecting the date the subscriber or subscriber’s dependent enrolled in Medicaid or CHIP or the date at which the subscriber or subscriber’s dependent lost eligibility for Medicaid or CHIP
Employee or a dependent enrolls in a state premium assistance subsidy for SEBB health plan from Apple Health (Medicaid) or a state CHIP. Yes No Yes No Yes Eligibility letter from Medicaid or CHIP
Employee or a dependent enrolls in or loses eligibility for coverage under Medicare. No No Yes Yes Yes Security denial letter; Medicare entitlement or cessation of disability form
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 Cancellation letter from the health plan; coverage confirmation in a new health plan; Medicare entitlement letter; copy of current tax return claiming employee as a dependent
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. No No Yes, if approved by the SEBB Program No No Submit request for a plan change to:
Health Care Authority
SEBB Program
PO Box 42684
Olympia, WA 98504-5502
Employee or dependent becomes eligible and enrolls in a TRICARE plan, or loses eligibility for a TRICARE plan. No No No Yes Yes Certificate of credible coverage; proof of enrollment or termination of coverage from TRICARE

  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 health plan coverage if the dependent enrolls in the new spouse's or state-registered domestic partner's plan.

3 Waiving for this event is allowed only if the employee enrolls in medical under the new spouse or state-registered domestic partner’s employer-based group health plan.

When SEBB Program coverage ends

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 benefits 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. Benefits end the last day of the month in which the change is effective.

What are my options when coverage ends?

If applicable, you may be eligible to enroll on your spouse’s, state-registered domestic partner’s, or parent’s SEBB insurance coverage as a dependent.

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. This is called SEBB Continuation Coverage.

There are three possible continuation coverage options you and your eligible dependents may qualify for:

  1. SEBB Continuation Coverage (COBRA)
  2. SEBB Continuation Coverage (Unpaid Leave)
  3. PEBB retiree insurance coverage

The first two options temporarily extend SEBB health plan coverage when your or your dependents’ SEBB health plan coverage ends due to a qualifying event. If you qualify for both SEBB Continuation Coverage options, you may choose to enroll in only one of the options.