What is 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.

My special open enrollment event is ...

Marriage or registering a domestic partnership

As defined by Washington Administrative Code 182-31-020.

Action	Allowed?
Add dependent	Yes
Change medical plan	Yes (A health plan change is not allowed when adding a SRDP or their child if they are not a tax dependent.)
Change 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.)

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 or adoption

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

Action	Allowed?
Add dependent	Yes
Change medical plan	Yes
Change dental/vision plan	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

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

Action	Allowed?
Add dependent	Yes
Change medical plan	Yes
Change dental/vision plan	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 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
Change medical plan	Yes
Change dental/vision plan	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 employment status affects your eligibility for the employer contribution toward your employer-based group health plan. 

Action	Allowed?
Add dependent	Yes
Change medical plan	Yes
Change dental/vision plan	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

Subscriber's dependent has a change in their employment status

The change affects their eligibility for the employer contribution under their employer-based group health plan.

Action	Allowed?
Add dependent	Yes
Change medical plan	Yes
Change dental/vision plan	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 under other employer-based group health plan's open enrollment

You or your 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 dependents	Yes
Change medical plan	No
Change dental/vision plan	No

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 county to the U.S. or from the U.S. to another country

 Your dependent's change in residence resulted in the loss of their health insurance.

Action	Allowed?
Add dependent	Yes
Change medical plan	No
Change dental/vision plan	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
Change medical plan	Yes
Change dental/vision plan	Yes

Documents to submit

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

Court order

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

Action	Allowed?
Add dependent	Yes
Change medical plan	Yes
Change dental/vision plan	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 Children's Health Insurance Program (CHIP).

Action	Allowed?
Add dependent	Yes
Change medical plan	Yes
Change dental/vision plan	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 subsidy for SEBB health plan coverage from Medicaid or CHIP

You or your dependent becomes eligible for a state premium assistance subsidy for SEBB health plan coverage from Medicaid or a CHIP. 

Action	Allowed?
Add dependent	Yes
Change medical plan	Yes
Change dental/vision plan	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
Change medical plan	Yes
Change dental/vision plan	No

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

 You or your dependent's current health plan becomes unavailable because you or your dependent are no longer eligible for a health savings account (HSA).

Action	Allowed?
Add dependent	No
Change medical plan	Yes
Change dental/vision plan	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

Continuity of care

You or your dependent experiences a disruption of care that could function as a reduction in benefits for the subscriber or their dependent for a specific condition or ongoing course of treatment. Requires approval by the SEBB Program.

Action	Allowed?
Add dependent	No
Change medical plan	Yes
Change dental/vision plans	Yes

Documents to submit

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

Change in school district

 You have a change in employment from a SEBB organization to a school district that results in having different medical plans available.

Action	Allowed?
Add dependent	No
Change medical plan	Yes
Change dental/vision plan	Yes

Documents to submit

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

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.

• Proof of the event
• The appropriate form:
  • SEBB Continuation Coverage (COBRA) Election/Change
  • SEBB Continuation Coverage (Unpaid Leave) Election/Change form

(See SEBB Program Policy Addendum 45-2A 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, the SEBB Program 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.

Related laws and rules

For details on changes you can make

See SEBB Program Policy Addendum 45-2A.

For subscribers

• 182-30-090: When may a subscriber change health plans?
• 182-31-150: When may subscribers enroll or remove eligible dependents?

For employees

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)?