Special open enrollment

What changes can I make?

The following changes may be allowed as a special open enrollment. See the special open enrollment matrix for details. 

You must request the changes in Benefits 24/7 or your payroll or benefits office must receive your forms and proof of the event no later than 60 days after the event.

My special open enrollment event is ...

Marriage or registering a domestic partnership

As defined by Washington Administrative Code (WAC) 182-30-020. 

Action	Allowed?
Add dependent	Yes (You may add only the new spouse, state-registered domestic partner, or children of the spouse or partner. Existing noncovered dependents may not be added.)
Remove dependent	Yes (You 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 you enroll in medical under your new spouse or state-registered domestic partner's employer-based group health plan.)
Enroll after waiving SEBB medical coverage	Yes (You may enroll yourself to enroll your new spouse and children. Existing noncovered dependents may not be enrolled.)

Documents to submit

• Marriage certificate
• Certificate of state-registered domestic partnership or legal union and the SEBB Declaration of Tax Status

Birth or adoption

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

Action	Allowed?
Add dependent	Yes (You may also enroll a spouse or state-registered domestic partner but may not enroll existing noncovered dependent children.)
Remove dependent	Yes
Change SEBB medical, dental, vision plan	Yes
Waive SEBB medical coverage	Yes  (Waiving for this event is allowed only if you enroll in medical under your 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.

Newly eligible extended dependent

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.

Loss of other coverage

You or your 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

You have a change in employment status

Your change in employment status affects your eligibility for your employer contribution toward your 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 you enroll in medical under your 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

Your dependent has a change in their employment status

The change affects their eligibility or their dependent's eligibility for their 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 you enroll in medical under your 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

Change in school district

You have 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

Change under other employer-based group health plan's open enrollment

You or a dependent have 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 you enroll in medical under your 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

Your dependent moves from another country to the U.S. or from the U.S. to another country

Your dependent's change in residence results in the loss of 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)

Change in residence

You or your 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	No
Enroll after waiving SEBB medical coverage	No

Documents to submit

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

Court order

 A court order requires your or your dependent to provide insurance coverage for an eligible child. 

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

Gain or lose eligibility for Medicaid or CHIP

You or your 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

Become eligible for state premium assistance subsidy for SEBB medical plan coverage from Medicaid or CHIP

You or your 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

Gain or lose eligibility for Medicare

You or your dependent enrolls in or loses eligibility for coverage under Medicare. 

Action	Allowed?
Add dependent	Yes (You may enroll a dependent who lost eligibility for coverage under Medicare. Existing noncovered dependents who did not lose Medicare eligibility may not be enrolled.)
Remove dependent	Yes (A health plan change is not allowed when adding an SRDP or their child if they are not a tax dependent.)
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

Medical plan becomes unavailable

Your or your dependent's health plan becomes unavailable because you or your 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	No

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.

Continuity of care

You or your dependent experiences a disruption of care for active and ongoing treatment that could function as a reduction in benefits. 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

• School Employee Change Form (or use Benefits 24/7)
• Letter or appeal explaining the situation and why you want or need the plan change.

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

Gain or lose eligibility for TRICARE

You or your 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

How do I make changes?

Submit your changes and your proof of event (for example, a marriage or birth certificate) in Benefits 24/7 or submit required forms and supporting documents to your payroll or benefits office no later than 60 days after the event.

See the special open enrollment matrix for a list of valid documents.

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.

When to submit when 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, you must make the request in Benefits 24/7 or your payroll or benefits office must receive the required forms no later than 60 days after the date of the birth, adoption, or when you assumed legal obligation.

Related laws and rules

For more details about the changes you can make during these events, see SEBB Program Administrative Policy Addendum 45-2A and refer to the following Washington Administrative Code (WAC) sections:

• WAC 182-30-090: When may a subscriber change health plans?
• WAC 182-30-100: When may a school employee enroll or revoke an election and make a new election under the premium payment plan, medical flexible spending arrangement (FSA), or dependent care assistance program (DCAP)?
• WAC 182-31-080: When may a school employee waive enrollment in school employees benefits board (SEBB) medical and when may they enroll in SEBB medical after having waived enrollment?
• WAC 182-31-150: When may subscribers enroll or remove eligible dependents?