How to determine eligibility

Learn about your eligibility for SEBB benefits. 

Am I eligible?

Your employer will determine if you are eligible for SEBB benefits based on eligibility in WAC 182-31-040 and your specific employment circumstances. Paid holidays do not count toward the required hours, except for if you are hired late in the school year. View the eligibility basics infographic and fact sheet.

You have the right to appeal the eligibility determination. Visit File an appeal: SEBB to learn how to appeal.

If you, or your children, are currently enrolled in Washington Apple Health (Medicaid) coverage, read the SEBB Apple Health fact sheet.

When do eligibility and coverage begin?

If you meet the eligibility criteria, you will sign up during the first annual open enrollment, October 1 through November 15, 2019. Coverage will begin January 1, 2020. There are some exceptions for specific situations.

If your work pattern or schedule changes

If you are not eligible for SEBB benefits at the beginning of the school year, but your work circumstance changes and your employer now anticipates you will work 630 hours during the school year, you become eligible when your employer tells you about the change. Your coverage begins the first day of the following month.

If you are not anticipated to work 630 hours at the beginning of the school year, but you do actually reach 630 hours, you become eligible on that day. Your coverage begins the first day of the following month.

If you are eligible for SEBB benefits at the beginning of the year, but your work schedule is revised so that you are no longer anticipated to work 630 hours during the school year, your eligibility and your coverage end the last day of the month in which the change is effective.

Eligibility based on hours worked the previous two years

If you work at least 630 hours in two consecutive school years and are returning to the same type of position(s) in the same SEBB organization (school district, participating educational service district, or charter school), you are presumed eligible for SEBB benefits the third year.

If your district does not consider you eligible after having worked at least 630 hours the previous two consecutive school years, they must notify you in writing of the specific reasons that you are not anticipated to work at least 630 hours. You have the right to appeal the eligibility determination. The letter from your employer will have instructions on how to appeal.

If you work in more than one SEBB organization

All of your hours worked as a school employee within the same school district or charter school, or as a represented employee of the same educational service district (ESD) count in the calculation of hours to determine your eligibility. You cannot “stack” hours from different organizations to reach the eligibility. 

Returning school employees have uninterrupted coverage

Once you are enrolled, you will receive uninterrupted coverage from one school year to the next as long as:

  • You receive SEBB benefits at the end of a school year, and
  • Your employer anticipates you will work at least 630 compensated hours the following year.

If you are hired mid-year

If you start work at any time during the year after the first day of school, and you are eligible for benefits for that school year, your coverage begins on the first day of the following month.

If you are hired late in the school year and because of the time of year you are hired, you are not anticipated to work 630 compensated hours before the end of the year, and you are anticipated to work 630 hour during the following year, you will be eligible for benefits if one of the following situations apply:

  • You are hired as a 9- to 10-month school employee and your employer anticipates you will work at least 17.5 compensated hours a week in six of the last eight weeks before the last day of school.
  • You are hired as a 12-month school employee and your employer anticipates you will work at least 17.5 compensated hours a week in six of the last eight weeks before the end of the school year (August 31).

Changing jobs to between SEBB organizations

Once enrolled, you will have uninterrupted coverage when moving from one SEBB organization to another within the same or following month, and you are anticipated to be eligible for the employer contribution in your new position.

When do eligibility and coverage end?

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.

What if I work fewer than 630 hours in a school year?

If you are anticipated to work fewer than 630 hours, you may be eligible for some benefits based on RCW 41.05740(6)(e), which allows your employer to locally negotiate eligibility criteria at a lower threshold of hours. This is sometimes referred to as "locally eligible employees."

Employees eligible for locally negotiated benefits: If you are not eligible as described in this eligibility section, you may be eligible for some SEBB benefits if your school district, charter school, or ESD negotiated eligibility as described in WAC 182-30-130. If you are represented, please check with your union or union representative regarding eligibility. Otherwise, your payroll or benefits office will notify you if you are eligible under this provision.

Are my dependents eligible?

Eligible school employees enrolled in SEBB benefits may enroll the following dependents:

How are children defined?

Children are defined as:

children with whom you have a parent-child relationship as defined in RCW 26.26.101 except when parental rights have been terminated. This definition includes:

  • Your children
  • Children of your spouse
  • Children for whom you have assumed a legal obligation for total or partial support in anticipation of adoption
  • Children of your state-registered domestic partner
  • Children specified in a court order or divorce decree to provide support or health care coverage.

Eligible extended dependents

Eligible school employees enrolled in SEBB benefits may enroll a child up to age 26 that is an extended dependent in the legal custody or legal guardianship of the school employee, the school employee's spouse, or the school employee's state-registered domestic partner. The legal responsibility is demonstrated by a valid court order and the child's official residence with the custodian or guardian. Extended dependent child does not include a foster child unless the school employee, the school employee’s spouse, or the school employee’s state-registered domestic partner has assumed a legal obligation for total or partial support in anticipation of adoption. In addition to dependent verification documents also submit the SEBB Extended Dependent Certification form.

Eligible children with disabilities age 26 and older

Eligible children also include children of any age with a developmental disability or physical handicap that renders the child incapable of self-sustaining employment and chiefly dependent upon the employee for support and ongoing care, provided the condition occurred before age 26. You must provide evidence of the disability and evidence the condition occurred before age 26 and their certification is approved.

How do I add my disabled dependent?

During the SEBB Program's first annual open enrollment

  • If you are a currently enrolled member of the Public Employees Benefits Board (PEBB) Program you are not required to recertify your child. Your certification will be migrated into SEBB My Account. Nothing further will be required until the next recertification period. Note: You must take action to enroll your child on to your new SEBB health plan. This process does not replace the need for you to request that this dependent be added to your benefits.
  • If you are a school employee currently enrolled in your SEBB organization’s health plan (and not enrolled in PEBB benefits), your SEBB organization’s payroll or benefits office is authorized to attest to your dependent child’s disability status if the child is currently enrolled under the SEBB organization’s current health plan, based on eligibility as a dependent child age 26 or older with a disability. The attestation may be based on the following;
    • Existing school district, charter school, or participating educational service district enrollment record finding the dependent child eligible at age 26 or older based on disability; or
    • Visual verification of a document from the organization’s current health plan finding the dependent child eligible at age 26 or older based on disability.
    • For a child with a disability who will turn age 26 on or before December 31, 2019, the SEBB organization can continue to verify and attest through December 31, 2019. 
  • If you are a school employee and not currently enrolled in PEBB benefits and unable to obtain an attestation from your SEBB organization, you must request enrollment of your child, follow the process for initial certification.
    • You must submit a completed SEBB Certification of Child with a Disability form to the selected carrier or send to the SEBB Program. Please reference the form for contact information.
    • The SEBB Program, with input from your medical plan (if applicable), will verify the disability of a child beginning at age 26, but no more frequently than annually after the two-year period following the child’s 26th birthday, which will require recertification from you and your dependent’s provider.

Surviving dependents eligibility

If you die, your dependents will lose their eligibility for the employer contribution toward SEBB Program benefits. They may be eligible to enroll in PEBB Program retiree insurance coverage as your survivor, instead of enrolling in SEBB Continuation Coverage. If eligible, your surviving spouse or state-registered domestic partner has PEBB Program retiree insurance coverage available for life and it is available for your surviving children up to the limiting age for child eligibility.