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Special open enrollment

Some life events (marriage, birth of a child, etc.) qualify you to make changes to your benefits outside of our annual open enrollment. We call these events and the time period you have to make changes (60 days) a "special open enrollment."

Do you need to change your coverage? 

Sign in to SEBB My Account

What changes can I make?

Based on the event, the following changes may be allowed as a special open enrollment.

As defined by WAC 182-30-020

Action

Allowed?

Add dependent

Yes
(Employee may add only the new spouse, state-registered domestic partner, or children of the spouse or partner. Existing dependents may not be added.)

Remove dependent

Yes
(Employee may only remove a dependent from SEBB coverage if the dependent enrolls in the new spouse’s or state-registered domestic partner’s plan.)

Change SEBB medical, dental, vision plan Yes
(A health plan change is not allowed when adding a SRDP or their child if they are not a tax dependent.)
Waive SEBB medical coverage Yes
(Waiving for this event is allowed only if the employee enrolls in medical under the new spouse or state-registered domestic partner's employer-based group health plan.)
Enroll after waiving SEBB medical coverage Yes

Documents to submit

  • Marriage certificate.
  • Certificate of state-registered domestic partnership or legal union and the SEBB Declaration of Tax Status.
  • Also provide evidence the marriage/partnership is still valid (e.g., a utility bill or bank statement) dated within the past six months showing both names.

If the marriage or state-registered domestic partnership is within six months, only a marriage certificate or certificate of state-registered domestic partnership or legal union is required.

Birth, adoption, or assuming a legal obligation for support in anticipation of adoption.  

Action

Allowed?

Add dependent

Yes

Remove dependent

Yes

Change SEBB medical, dental, vision plan Yes
Waive SEBB medical coverage Yes 
(Waiving for this event is allowed only if the employee enrolls in medical under the new spouse or state-registered domestic partner's employer-based group health plan.)
Enroll after waiving SEBB medical coverage Yes

Documents to submit

  • Birth certificate (or hospital certificate with child’s footprints).
  • Certificate or decree of adoption.
  • Placement letter from adoption agency.
  • SEBB Declaration of Tax Status if adding child of a state-registered domestic partner.

All valid documents for proof of this event must show the name of the parent who is the subscriber, subscriber’s spouse, or the subscriber’s state-registered domestic partner.

Child becomes eligible as an extended dependent through legal custody or legal guardianship. 

Action

Allowed?

Add dependent

Yes

Remove dependent

No

 

Change SEBB medical, dental, vision plan Yes
Waive SEBB medical coverage No
Enroll after waiving SEBB medical coverage Yes

Documents to submit

Employee or dependent loses eligibility for other coverage under a group health plan or through health insurance, as defined by the Health Insurance Portability and Accountability Act (HIPAA). 

Action

Allowed?

Add dependent

Yes

Remove dependent

No

Change SEBB medical, dental, vision plan Yes
Waive SEBB medical coverage No
Enroll after waiving SEBB medical coverage Yes

Documents to submit

  • Certificate of creditable coverage.
  • Letter of termination of coverage from health plan or payroll or benefits office.
  • COBRA election notice.

Employee has a change in employment status that affects their eligibility for their employer contribution toward their employer-based group health plan.  

Action

Allowed?

Add dependent

Yes

Remove dependent

Yes

Change SEBB medical, dental, vision plan Yes
Waive SEBB medical coverage Yes
(Waiving for this event is allowed only if the employee enrolls in medical under the new spouse or state-registered domestic partner's employer-based group health plan.)
Enroll after waiving SEBB medical coverage Yes

Documents to submit

  • Employee hire letter from employer that contains information about benefits eligibility.
  • Employment contract.
  • Termination letter.
  • Letter of resignation.
  • Statement of insurance.
  • Certificate of coverage.

Employee's dependent has a change in their own employment status that affects their eligibility for the employer contribution under their employer-based group health plan.

Note: "Employer contribution" means contributions made by the dependent's current or former employer toward health coverage as described in Treasury Regulation 54.9801-6.

Action

Allowed?

Add dependent

Yes

Remove dependent

Yes

 

Change SEBB medical, dental, vision plan Yes
Waive SEBB medical coverage Yes
(Waiving for this event is allowed only if the employee enrolls in medical under the new spouse or state-registered domestic partner's employer-based group health plan.)
Enroll after waiving SEBB medical coverage Yes

Documents to submit

  • Employee hire letter from their employer that contains information about benefits eligibility.
  • Employment contract.
  • Termination letter.
  • Letter of resignation.
  • Statement of insurance.
  • Certificate of coverage.

Employee has a change in employment from a SEBB organization to a public school district that results in having different medical plans available.  

Action

Allowed?

Add dependent

No

Remove dependent

No

Change SEBB medical, dental, vision plan Yes
Waive SEBB medical coverage No
Enroll after waiving SEBB medical coverage No

Documents to submit

  • Employee hire letter from their employer that contains information about benefits eligibility.
  • Employment contract.

 Employee or dependent has a change in enrollment under another employer-based group health plan during its annual open enrollment that does not align with the SEBB Program’s annual open enrollment.

Action

Allowed?

Add dependent

Yes

Remove dependent

Yes

Change SEBB medical, dental, vision plan No
Waive SEBB medical coverage Yes
(Waiving for this event is allowed only if the employee enrolls in medical under the new spouse or state-registered domestic partner's employer-based group health plan.)
Enroll after waiving SEBB medical coverage Yes

Documents to submit

  • Certificate of credible coverage.
  • Letter of enrollment or termination of coverage from the health plan.
  • Letter of enrollment or termination of coverage from the employer’s payroll or benefits office.
  • Proof of waiver.

 Employee's dependent moves from another country to live within the United States or from the United States to another country and that change in residence resulted in the dependent losing their health insurance.

Action

Allowed?

Add dependent

Yes

Remove dependent

Yes

Change SEBB medical, dental, vision plan No
Waive SEBB medical coverage No
Enroll after waiving SEBB medical coverage Yes

Documents to submit

  • Visa or passport with date of entry
  • Proof of former and current residence (e.g. utility bill)
  • Letter or document showing coverage was lost (e.g. certificate of credible coverage).

Employee or dependent has a change in residence that affects health plan availability.

Action

Allowed?

Add dependent

No

Remove dependent

No

Change SEBB medical, dental, vision plan Yes
Waive SEBB medical coverage Yes
Enroll after waiving SEBB medical coverage No

Documents to submit

  • Proof of former and current residence (e.g. utility bill).
  • Certificate of credible coverage. 

 A court order requires the employee or any other individual to provide insurance coverage for an eligible child of the employee. 

Action

Allowed?

Add dependent

Yes

Remove dependent

Yes

Change SEBB medical, dental, vision plan Yes
Waive SEBB medical coverage No
Enroll after waiving SEBB medical coverage Yes

Documents to submit

  •  Valid court order.

Employee or dependent enrolls in or loses eligibility for Medicaid or a state Children’s Health Insurance Program (CHIP). 

Action

Allowed?

Add dependent

Yes

Remove dependent

Yes

Change SEBB medical, dental, vision plan Yes
Waive SEBB medical coverage No
Enroll after waiving SEBB medical coverage Yes

Documents to submit

  • Enrollment or termination letter from Medicaid or CHIP reflecting the date the employee or employee's dependent enrolled in Medicaid or CHIP or the date at which they lost eligibility for Medicaid or CHIP.

Employee or a dependent becomes eligible for a state premium assistance subsidy for SEBB medical plan from Medicaid or a state CHIP. 

Action

Allowed?

Add dependent

Yes

Remove dependent

No

Change SEBB medical, dental, vision plan Yes
Waive SEBB medical coverage No
Enroll after waiving SEBB medical coverage Yes

Documents to submit

  • Eligibility letter from Medicaid or CHIP.

Employee or dependent enrolls in or loses eligibility for coverage under Medicare. 

Action

Allowed?

Add dependent

Yes

Remove dependent

Yes

Change SEBB medical, dental, vision plan Yes
Waive SEBB medical coverage Yes
Enroll after waiving SEBB medical coverage Yes, only allowed if lost eligibility for Medicare

Documents to submit

  • Medicare benefit verification letter.
  • Copy of Medicare card.
  • Notice of denial of Medicare coverage.
  • Social Security denial letter.
  • Medicare entitlement or cessation of disability form.

Employee's or dependent’s current health plan becomes unavailable because the employee or dependent is no longer eligible for a health savings account (HSA). 

Action

Allowed?

Add dependent

No

Remove dependent

No

Change SEBB medical, dental, vision plan Yes
Waive SEBB medical coverage No
Enroll after waiving SEBB medical coverage Yes

Documents to submit

  • Cancellation letter from the health plan.
  • Coverage confirmation in a new health plan.
  • Medicare entitlement letter
  • Copy of current tax return claiming you as a dependent.

Employee or dependent experiences a disruption of care for active and ongoing treatment that could function as a reduction in benefits for the employee or their dependent (requires approval by the SEBB Program). 

Action

Allowed?

Add dependent

No

Remove dependent

No

Change SEBB medical, dental, vision plan Yes, if approved by the SEBB Program
Waive SEBB medical coverage No
Enroll after waiving SEBB medical coverage No

Documents to submit

  • Submit request for a plan change to:
    Health Care Authority
    SEBB Program
    PO Box 42720
    Olympia, WA 98504-2720

Employee or dependent becomes eligible and enrolls in a TRICARE plan, or loses eligibility for a TRICARE plan. 

Action

Allowed?

Add dependent

No

Remove dependent

No

Change SEBB medical, dental, vision plan No
Waive SEBB medical coverage Yes
Enroll after waiving SEBB medical coverage Yes

Documents to submit

  • Certificate of credible coverage
  • Proof of enrollment or termination of coverage from TRICARE.

For more details about the changes you can make during these events, see SEBB Program Administrative Policy Addendum 45-2A

How do I make changes?

To take advantage of special open enrollments, your payroll or benefits office must receive the following forms and documentation no later than 60 days after the event.

  • Your proof of the event.
  • The required enrollment/change forms. You may complete this in SEBB My Account.

(See SEBB Program Administrative Policy Addendum 45-2A for a list of valid documents.)

Things to know

  • When to submit. You may want to submit your request sooner to avoid a delay in the enrollment or change, and to ensure timely payment of claims.
  • Adding a child. When the special open enrollment is for birth, adoption, or assuming legal obligation for support ahead of adoption, submit the required forms and proof of your dependent’s eligibility and the event as soon as possible. If adding the child increases the premium, your employer must receive the required forms and proof no later than 60 days after the date of the birth, adoption, or when you assumed legal obligation.

Contact

Your payroll or benefits office