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How to determine eligibility

Learn about your eligibility for SEBB benefits. 

Am I eligible?

Generally, you are eligible for SEBB benefits if you work for a Washington State school district or charter school, or are a represented employee of an educational service district, and your employer anticipates you will work at least 630 hours per school year (September 1 through August 31). Paid holidays and paid leave, such as sick, personal, and bereavement leave, count toward the required hours.

Your employer will determine if you are eligible for SEBB benefits based on eligibility in WAC 182-31-040 and your specific work circumstances.

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

When do eligibility and benefits begin?

For newly hired employees who meet the eligibility criteria, your eligibility begins on your first workday, and your benefits begin on the first day of the following month.

Special rules apply for new employees who begin work on or after September 1, but not later than the first day of school. For those employees only, eligibility and benefits begin on your first day of work.

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 on the date your work pattern is revised.

If you are not anticipated to work 630 hours at the beginning of the school year, but you do actually work 630 hours, you become eligible on the date you work your 630th hour. Benefits begin on the first day of the following month. If eligibility is established in the month of August, benefits begin on September 1 only if you are determined eligible for the employer contribution toward SEBB benefits for the school year that begins on September 1. 

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 for the employer contribution toward SEBB benefits ends the last day of the month in which the change in your work schedule is effective.

If you return to work from approved leave without pay, you can maintain or establish eligibility for the employer contribution toward SEBB benefits if the schedule you return to, had it been in effect at the start of the school year, would have resulted in you being anticipated to work the minimum hours to be eligible for SEBB benefits. You would regain eligibility for the employer contribution toward SEBB benefits on the day you return from approved leave without pay. Benefits will begin the first day of the following month. If eligibility is established in the month of August, SEBB benefits begin on September 1 only if you are determined eligible for the employer contribution toward SEBB benefits for the school year that begins on September 1.

Eligibility based on hours worked the previous two school years

If you work at least 630 hours in each of the previous two school years and are returning to the same type of position or combination of positions in the same SEBB organization (school district, educational service district, or charter school), you are presumed eligible for the employer contribution toward SEBB benefits at the start of the third year. When calculating hours worked, the SEBB organization will include hours of paid leave (e.g., personal leave hours you used) and paid holidays.

If your employer does not consider you eligible after having worked at least 630 hours the previous two school years, they must notify you in writing of the specific reasons why you are not anticipated to work at least 630 hours in the current school year. 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 position within one SEBB organization

All of your paid hours (including paid leave hours, and paid holidays) 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 school districts, charter schools, or ESDs to reach the eligibility level of 630 hours.

Returning school employees have uninterrupted coverage

If you were enrolled in SEBB benefits in August of the previous school year, you will receive uninterrupted coverage from one school year to the next as long as you are still anticipated to be eligible for the employer contribution the coming school year.

If you are hired mid-year

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 hours before the end of the year, and you are anticipated to work 630 hours during the following school year, you will be eligible for the employer contribution toward SEBB 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 between SEBB organizations

Once enrolled in benefits, 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 toward SEBB benefits in your new position.

When do eligibility and benefits 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 benefits end the last day of the month in which the termination notice is effective.
  • You resign. Eligibility and benefits end 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 hours during the school year. Benefits end 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 41.057.40(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:

  • Your legal spouse
  • Your state-registered domestic partner, as defined in WAC 182-30-020.
    This includes substantially equivalent legal unions from other jurisdictions as defined in RCW 26.60.090. Strict requirements apply to these partnerships, including that one partner is age 62 or older and you live in the same residence.
  • Your children, as defined in WAC 182-31-140 (3), up to the last day of the month in which they turn age 26 (see below). Children with a disability may be covered past the age of 26 if they qualify.

When you enroll eligible dependents on your SEBB coverage, you are required to provide proof of their eligibility with a document that shows they are your dependents.

How are children defined?

Children are defined as children with whom you have a parent-child relationship as defined in RCW 26.26A.100 except when parental rights have been terminated. This definition includes:

  • Your children.
  • Children of your spouse.
  • Children you are legally required to support ahead of adoption.
  • Children of your state-registered domestic partner.
  • Children specified in a court order or divorce decree for whom you are legally required to provide support or health care coverage.
  • Children with disabilities age 26 and older.
  • Extended dependent children who meet specified eligibility criteria.

Eligible extended dependents

Children may also include extended dependents (such as a grandchild, niece, nephew, or other child) for whom you, your spouse or state-registered domestic partner are legal custodians or legal guardians. 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 you, your spouse, or your state-registered domestic partner are legally required to provide support ahead of adoption. Along with a copy of your valid court order, 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 them 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 before their certification can be approved.

How do I add my child with a disability?

You must provide evidence of the disability and evidence the condition occurred before age 26. The SEBB Program, with input from the medical plan (if applicable), will periodically verify the eligibility of a dependent child beginning at age 26, but no more frequently than annually after the two-year period following the child’s 26th birthday. Verification will require renewed proof of disability and dependence from you.

If the SEBB Program does not receive your recertification form within the time allowed, the child will no longer be covered and you will not be able to add the child back onto your coverage until you experience a special open enrollment event or during the next annual open enrollment period.

A child with a disability who becomes self-supporting is no longer eligible and their coverage will end as of the last day of the month in which they become capable of self-support. If the child becomes capable of self-support and later becomes incapable of self-support, the child does not regain eligibility as a child with a disability.

In addition to dependent verification documents also submit the SEBB certification of a Child with a Disability.

Surviving dependents eligibility

If you die, your dependents (a spouse, state-registered domestic partner, or dependent child) will lose their eligibility for the employer contribution toward SEBB benefits. They may be eligible to enroll or defer enrollment in PEBB 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 retiree insurance coverage available for life and it is available for your surviving children up to the limiting age for child eligibility.