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

Paid holidays and paid leave, such as sick, personal, and bereavement leave, count toward the required hours. Voluntary Employee Beneficiary Association (VEBA) cashout/buyout does not apply to the required hours.

Apple Health (Medicaid) and CHIP

If you're eligible, you can enroll in both SEBB benefits and Apple Health. But SEBB benefits eligible employees cannot waive SEBB enrollment in favor of Apple Health.

Eligible dependent children can be enrolled in both SEBB benefits and Apple Health for Kids.

If your child loses or becomes eligible for Apple Health for Kids after SEBB’s annual open enrollment has ended, that creates a 60-day special open enrollment event, in which you could change the child’s SEBB coverage.

Get more details about Apple Health for adults and children.

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 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.

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 employee 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.

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.

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 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).

Once enrolled in benefits, you will have uninterrupted coverage when moving from one SEBB organization to another within the same or following month, as long as 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 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.

Learn more about dependent eligibility.

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.