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What is special open enrollment?

Certain life events let you change your benefits outside of annual open enrollment. For example, you move to a new county, get married, or have a child. We call these “special open enrollment” events.

Learn what events qualify for special open enrollment and the steps you need to take to change your benefits.

Deadline to submit forms and documentation: The SEBB Program must receive your forms and proof of the event no later than 60 days after the event.

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 ...

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, 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.

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

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

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

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

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'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)

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

 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

 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.

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

 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

 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

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

 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.

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.

(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

Contact

The SEBB Program
Phone: 1-800-200-1004 
(TRS: 711)
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