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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
  • Are a represented employee of an educational service district
  • 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 and your specific work circumstances. (See WAC 182-31-040 for eligibility requirements.)

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.

If you are not eligible as described below, 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, check with your union or collective bargaining agreement regarding eligibility.

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. Your first day of work typically determines when your SEBB benefits begin.

For eligibility based on:

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 determined to be eligible by your employer, you are eligible on your first day of work. If start work at any other time your benefits being the first day of the following month.  

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. Benefits begin 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 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, if it had 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, charter school, or educational service district), 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 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 the hours you work in your capacity as a school employee, and all hours for which you receive compensation from your employer during an approved leave (including paid leave hours and paid holidays), are included in the hours to determine your eligibility. You cannot “stack” hours from different school districts, charter schools, or ESDs to reach eligibility.

If you were eligible for the employer contribution in SEBB benefits in August, 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 in 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).

You cannot enroll in medical, dental, or vision coverage under two SEBB accounts. If you are eligible as an employee and as a dependent under your spouse’s, state-registered domestic partner’s or parent’s account, see Waiving medical coverage for options available to you.

Effective January 1, 2022, if you are eligible to enroll in both the SEBB and Public Employees Benefits Board (PEBB) Programs, you are limited to a single enrollment in medical, dental, and vision (SEBB Program) or medical and dental (PEBB Program). If you do not take action to resolve the dual enrollment, the SEBB Program or PEBB Program will automatically enroll or disenroll you as described in WAC 182-31-070(6). You cannot enroll in both SEBB and PEBB health plans.

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 eligible in the previous position and 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:

  • Eligibility and benefits end the last day of the month in which the termination notice is effective.
  • Eligibility and benefits end the last day of the month in which your resignation is effective.

If 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.

If you return from approved leave without pay* and have a change in work pattern that, if it had been in effect at the start of the school year, would not have resulted in you being anticipated to work the minimum hours to meet SEBB eligibility for the employer contribution:

  • Eligibility for the employer contribution ends as of the last day of the month in which the change is effective.

*See WAC 182-31-040(4)(d) for details.

If you are a 9- or 10-month school employee hired late in the school year and were eligible for SEBB benefits*, but you have a change in work pattern and are no longer anticipated to be compensated for at least 17.5 hours a week in six of the last eight weeks before the week that contains the last day of school:

  • Eligibility for the employer contribution ends as of the last day of the month in which the change is effective.

*See  WAC 182-31-040(4)(c)(i) for details.

If you are a 12-month school employee hired late in the school year and were eligible for SEBB benefits*, but you have a change in work pattern and are no longer anticipated to be compensated for at least 17.5 hours a week in six of the last eight weeks before the week that contains August 31:

  • Eligibility for the employer contribution ends as of the last day of the month in which the change is effective. 

*See WAC 182-31-040(4)(c)(ii) for details.

If you are hired late in the school year and were eligible for SEBB benefits*, but are no longer anticipated to work 630 hours in the next school year:

  • Eligibility for the employer contribution ends the last day of the month in which the change in anticipation occurs.

*See WAC 182-31-040(4)(c) for details.

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 collective bargaining agreement 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. Learn more about survivor eligibility.