Medical plans and benefits

Fully insured medical plans

Fully insured plans are offered by commercial carriers under contract with the Health Care Authority (HCA). The carrier chooses what is covered and negotiates rates with us.

HCA announced apparently successful bidders for SEBB fully insured medical plans on August 27, 2018. On November 8, 2018, the SEB Board endorsed the proposed fully insured medical plan designs for the purpose of rate development.

The SEBB Program is negotiating with the carriers listed below. Plan designs and determination of costs are still in progress. We will update benefit information as details become available.

• Aetna
• Kaiser Permanente Northwest
• Kaiser Permanente Washington
• Kaiser Permanente Washington Options
• Premera Blue Cross
• Providence Health Plan

Self-insured medical plans

Self-insured plans are offered by the HCA, which develops the benefit designs and has more control over plan costs. Our self-insured medical plan is called Uniform Medical Plan (UMP) and is managed for us by Regence BlueShield. UMP will offer four medical health plans, with a range of coverage and costs. Details will be available in time for open enrollment.

The SEB Board voted on June 13, 2018 to offer four self-insured plans with features similar to the Uniform Medical Plan offered under the Public Employees Benefits Board Program. Features include covered benefits, provider networks, clinical policies, and an integrated pharmacy benefit. Offerings are subject to final financing decisions by the state.

The self-insured plans approved on June 13 include:

• A self-insured plan with the same coverages and exclusions, provider networks, and clinical policies as the 2020 UMP Classic plan under the PEBB Program;
• A self-insured plan similar to the 2020 UMP Classic plan, but with different deductibles and coinsurances;
• A self-insured plan with the same coverages and exclusions, provider networks, and clinical policies as the 2020 UMP Consumer-Directed Health plan under the PEBB Program; and
• A self-insured plan with the same coverages and exclusions, provider networks, and clinical policies as the 2020 UMP Plus plan under the PEBB Program.

The SEB Board has the option of customizing the self-insured plans by amending the June 13 resolutions. The changes could include:

• Modifying dollar amounts and limits on member cost sharing, such as deductibles, copays, coinsurance, maximum out-of-pocket costs, and out-of-network costs.
• Increasing or decreasing services with an annual visit limit.
• Changing each plan's list of covered and excluded services.