How to determine eligibility

Learn about your eligibility for SEBB benefits. We will add more information as it becomes available.

When are school employees eligible?

You are eligible for SEBB benefits if you work for a Washington State school district, educational service district (ESD), or charter school, and your employer anticipates you will work at least 630 hours per school year (September 1 through August 31). Paid holidays do not count toward the required hours.

Your employer will determine if you are eligible for SEBB benefits based on your specific employment circumstances. You have the right to appeal the eligibility determination. Your employer will have instructions on how to appeal.

When do eligibility and coverage begin?

For the initial SEBB launch, if you meet the eligibility criteria, you will sign up during open enrollment, October 1 through November 15, 2019. Coverage will begin January 1, 2020.

If you are a new employee

After the initial open enrollment, if you are eligible and you start work on or after September 1, but not later than the first day of school, your eligibility for SEBB benefits and coverage begin on your first day.

In most cases, if you start at any other time during the year, your eligibility for SEBB benefits begins on your first workday and coverage begins on the first day of the following month. There are some exceptions for specific situations:

If your work pattern or schedule changes

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

If you are not eligible for SEBB benefits at the beginning of the school year, but your work schedule is increased 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:

And this happens:

Your eligibility:

Your coverage:

Eligible for SEBB benefits at the beginning of the school year

Your schedule is reduced to less than 630 hours during the year

Ends on the day your schedule changes

Ends the last day of the month that change is effective

Not eligible for SEBB benefits at the beginning of the school year

Your schedule is increased to 630 hours or more during the school year

Begins the day you're notified of the change

Begins the first of the month following eligibility

Not eligible for SEBB benefits at the beginning of the school year

You reach 630 hours or more during the school year

Begins the day you reach 630 hours

Begins the first of the month following eligibility

If you work in more than one district

You must earn hours that count toward eligibility within a single school district, educational service district (ESD), or charter school. You can’t “stack” hours from different school districts, ESDs, or charter schools to reach the eligibility level of 630 hours. If you are eligible in more than one district, you decide which district will be your employer for purposes of eligibility in the SEBB Program.

Returning after summer break

Your benefits will carry over, uninterrupted, from one school year to the next if:

  • 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 in the same position or combination of positions, and
  • You will be working in the same school district, ESD, or charter school.

Your employer must notify you in writing if they do not anticipate you will be eligible the following year, explaining the specific reason. You have the right to appeal the eligibility determination. The letter from your employer will have instructions on how to appeal.

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 district, educational service district, or charter school, you are presumed eligible for SEBB Program benefits the third year.

If your district does not consider you eligible, 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 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, your coverage begins on the first day of the following month.

If you are hired late in the school year and there are not enough days 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 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 to another school or district

You will have uninterrupted coverage when moving from one school district, ESD, or charter school to another within Washington State if:

  • You are eligible for SEBB benefits in the position you are leaving, and
  • You begin your new job within the same month or the month after you left the old one, and
  • Your new employer anticipates you will be eligible 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. Coverage ends the last day of the month in which the termination notice is effective.
  • You resign. 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?

Employees anticipated to work fewer than 630 hours may be eligible for some SEBB Program benefits. If you’re a union-represented employee, please check with your union or union contract regarding your eligibility. Otherwise, contact your employer’s payroll or benefits office.

The organization may only negotiate with these groups:

  • The entire organization;
  • An entire collective bargaining unit; or
  • All non-represented school employees.

If they offer this option, organizations must offer all of, and only, these SEBB Program benefits:

  • Medical (including the wellness incentive program)
  • Dental
  • Vision
  • Basic life and accidental death and dismemberment (AD&D)

The employee pays the employee share of the monthly medical premium, as well as deductibles and copays. The organization pays the full premiums for dental, vision, and basic life and AD&D insurance, as well as the employer share of the monthly medical premium.

The plans, premium tier ratios, and all other aspects of SEBB benefits are the same for this group as for those who work 630 hours or more per school year.

Are my dependents eligible?

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

Definition of children

Children are defined as children with whom you have a parent-child relationship as defined in RCW 26.26.101, stepchildren, 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, or children specified in a court order or divorce decree to provide support or health care coverage.

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.

Eligible children with disabilities

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. 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. If the SEBB Program does not receive your verification 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.

A child with a developmental disability or physical handicap who becomes self-supporting is not eligible 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.