Newly eligible employees

Eligibility for SEBB benefits

Employees establish eligibility based on categories described in WAC 182-31-040 and WAC 82-30-130. Eligibility is determined solely by the criteria of the category that most closely describes their work.

What hours are included when determining eligibility?

All hours worked by an employee in their capacity as a school employee must be included in the calculation of hours for determining eligibility. All hours for which a school employee receives compensation from a school employees benefits board (SEBB) organization during an approved leave (e.g., sick leave, personal leave, bereavement leave) or a paid holiday must be included when determining how many hours a school employee is anticipated to work, or did work, in the school year.

When calculating the hours a coach will work, the SEBB organization should consider the job description and the regular sport season schedule to determine the hours the school employee will be anticipated to work. If the schedule for the contract year is not available, the previous season's schedule may be used. The calculation of anticipated work hours could include the following as appropriate to the contract and the sport:

• Scheduled practices and games
• Travel time to attend games
• Other responsibilities as required, such as:
  • Supervising assistant coaches and completing reviews
  • Managing budget, equipment and inventory; including required maintenance
  • Monitor and enforce scholastic eligibility of players

The definition of school year allows school districts to start school in August and use the upcoming school year funds. If the school employee is working in August for the school year that is about to start the hours count towards the new school year. For example, if a school employee is working in August 2025 as part of their contract for the 2025-2026 school year the hours count towards the 2025-2026 school year. Those hours wouldn’t be applied to the 2024-2025 school year. Whether the first day of school is in August or September the work is to support the upcoming school year and the hours should be counted towards the new school year.

Employee categories

Newly hired employees

Newly hired employees are determined to be eligible for SEBB benefits if:

• Anticipated to work at least 630 hours in the school year; or
• Worked 630 hours in each of the two previous school years and are returning to the same type of position or combination of positions with the same SEBB organization are presumed to eligible at the start of the school year; or
• Not anticipated to work 630 hours during the current school year due to time of year they are hired, but are anticipated to do so the next school year:
  • 9-10 month school employee criteria based on hours worked in 6 of the last 8 weeks of school
  • 12 month school employee criteria based on hours worked in 6 of the last 8 weeks of the school year (August 31); or
• Employees eligible due to their SEBB organization engaging in local negotiations regarding SEBB benefits eligibility criteria

Employees who return from LWOP

Employees who return from approved leave without pay (LWOP) whose work schedule, had it been in effect at the start of the school year, would have resulted in the employee being anticipated to work the minimum hours to meet SEBB eligibility in the school year:

• Will maintain or establish eligibility for the employer contribution
• Employees who regain eligibility under this scenario, establish eligibility as of the date they return from approved LWOP.

Ineligible employees who become eligible

Ineligible employees may become eligible for SEBB benefits due to:

• Revised work pattern so as to now be anticipated to work at least 630 hours in the school year; or
• Actually end up working 630 hours in the school year

Determining eligibility using worksheets

SEBB provides worksheets as the method for determining eligibility.

SEBB organizations must use the worksheets provided by the SEBB Program to determine eligibility and enrollment in benefits. See WAC 182-31-030 and the SEBB Program administrative Policy 11-1.

Two-year lookback for school employees

For any returning school employee who is initially determined to not be eligible for the new school year, the employer needs to verify the employee does not meet the eligibility criteria of the two-year lookback provision.

A returning school employee is presumed eligible for SEBB benefits if they:

• Worked at least 630 hours in each of the previous two school years, and
• same type of position(s) with the same SEBB organization.

Examples of the same type of position include teacher, para-educator, food service worker, bus driver, etc.

Please review this list of scenarios for additional guidance associated with this topic.

Rebutting the presumption of eligibility

A school employee who meets the two-year lookback requirements is presumed eligible. However, a SEBB organization may rebut this presumption if it determines the employee is not anticipated to work at least 630 hours during the upcoming school year.

To rebut the resumption, the SEBB organization must provide the employee with written notice that:

• Explains the specific reasons the employee is not anticipated to work at least 630 hours during the upcoming school year, and
• Includes information about the employee’s right to appeal the eligibility determination.

Presumption of eligibility and two-year lookback

Under the two-year lookback, by the employee having worked at least 630 hours the last two school years, the “presumption of eligibility” implies that the employer should not wait for the employee to reach the 630 hour mark for a third consecutive year before determining the employee to be eligible. Instead, eligibility should be evaluated before the school year begins using the employee’s work history and the employer’s reasonable expectation of the employees’ hours for the upcoming school year.

When does coverage begin?

The date a school employee becomes eligible for the employer contribution toward SEBB benefits is not always the same as the date their coverage begins. For most months of the school year, coverage begins the first of the month following the date of eligibility. There is, however, an exception with the month of September (start of the school year).

Newly eligible school employee hired on or before the first day of school

If a new newly eligible school employee’s first day of work is between September 1 and the first day of school, the employee’s date of eligibility is the first day worked and the coverage effective date is also the first day worked. In order for Benefits 24/7 to apply this rule, the BA needs to correctly indicate if the employee's first day of work is on or before the first day of school.

Newly eligible school employees hired after the first day of school

If a newly eligible school employee’s first day of work is after the first day of school, then the employee’s date of eligibility is the first day worked. Coverage effective date is the first day of the following month.

Examples: Please review this list of examples/scenarios for additional guidance associated with this topic.