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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."
On this page
Do you need to change your coverage?
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 |
Remove dependent |
Yes |
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
- Valid court order showing legal custody, guardianship, or temporary guardianship, signed by a judge or officer of the court, a signed SEBB Extended Dependent Certification, and SEBB Declaration of Tax Status.
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