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How to determine eligibility

Learn about your eligibility for SEBB benefits. 

Am I eligible?

You are eligible for SEBB benefits if you work in a 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).

Due to a change made by the SEB Board effective January 1, 2020, all hours for which you receive compensation (for example, sick leave, personal leave, bereavement leave) and paid holidays, will be included when determining how many hours you are anticipated to work, or did work, in the school year.

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

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 Washington Apple Health and SEBB Program fact sheet.

When do eligibility and coverage begin?

For newly hired employees who meet the eligibility criteria, your eligibility begins on your first workday, and your coverage begins 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 coverage begin on your first day.

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 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, your SEBB organization will determine your eligibility by considering whether the work schedule you are returning to, had it been in effect at the start of the school year, would have resulted in meeting the 630-hour eligibility threshold. If you lost eligibility while on leave without pay, you would regain eligibility on the day you return from approved leave without pay. Coverage would begin the first day of the following month.

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. 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 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 paid hours (worked, 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 organizations to reach the eligibility.

Returning school employees have uninterrupted coverage

Once you are enrolled in benefits, 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 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 hours 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:

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 26.26.101 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?

You must provide evidence of the disability and evidence the condition occurred before age 26. The SEBB Program, with input from the health plan (if applicable), will periodically verify the disability and dependency of a child with a disability beginning at age 26, but no more than annually after the two-year period following the child’s 26th birthday, which will require recertification from you and your dependent’s provider. 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 or during the next annual open enrollment period.

A child with a developmental disability or physical handicap 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 form.

Surviving dependents eligibility

If you die, your dependents will lose their eligibility for the employer contribution toward SEBB benefits. They may be eligible to enroll 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.