FAQs for school administrators

Disallowing competing benefits is in the interest of ensuring HCA has the strongest negotiation position when setting rates with SEBB Program vendors and insurers. These limitations are in place to maintain the purchasing power that comes from consolidating all eligible school employees into one statewide risk pool through the SEBB Program. If an employer helps  school employees access a competing, non-SEBB Program insurance product, it would affect the risk profile of the SEBB Program population, which could affect the premiums or benefit structure of SEBB Program benefits.

Other reasons a SEBB organization cannot offer benefits authorized (but not offered) as part of the SEBB Program include:

• Policy considerations that maximize the value of all benefits when they are used in combination.
• Rate development that may have taken into account not offering certain benefit structures.

The formula for insuring SEBB organization employees and their dependents includes an estimated rate of employee waivers. If anticipated waivers weren’t factored in, that uncertainty would need to be funded by raising the amount employers pay  per employee for benefits. The state pools funds to pay for everyone enrolled in the program. Also, keep in mind that employees who waive medical will still receive other benefits.

The SEBB Program requires employees to provide documentation that verifies the relationship between the employee and their dependent(s) before they can be enrolled in an employee's SEBB medical, vision, and/or dental coverage.

The E-1 and E-2 worksheets, located on the Eligibility tools and worksheets page, provide guidance on the various types of allowed dependents and the type of documentation needed in order to verify the relationship with the employee.