SEB Board passes policy resolutions on wellness and continuation coverage

Fri, 01/25/2019

On January 24, 2019, the School Employees Benefits Board (SEB Board) approved four policy resolutions that will apply to eligible employees of Washington’s school districts, educational service districts (ESDs), and charter schools, starting January 1, 2020.

The approved resolutions establish that the SEBB Program will:

  • Allow an employee’s spouse or state-registered domestic partner to participate in SEBB wellness program activities.
  • Set the deadline for meeting SEBB wellness incentive program requirements.
  • Approve 29 months of self-pay coverage for employees.
  • Set the number of months that a school employee’s dependent who loses eligibility under the SEBB Program can continue SEBB Program enrollment on a self-pay basis.

Policy resolutions

The SEB Board approved the following policy resolutions. See pages 108, 109, 122, and 123 of the January 24 briefing book for details.

Eligibility for participation in the SEBB wellness program (SEBB 2018-55)

The spouse or state-registered domestic partner of an eligible school employee may participate in the SEBB wellness program activities, but is not eligible to receive a financial incentive.

Deadline for completing wellness activities (SEBB 2018-56)

Effective January 1, 2020, to receive a SEBB wellness incentive in the following plan year, eligible subscribers must complete SEBB wellness incentive program requirements by the following deadline:

  • For subscribers enrolling in SEBB medical with an effective date in January through September, the deadline is November 30.
  • For subscribers enrolling in SEBB medical with an effective date in October through December, the deadline is December 31.

Maximum number of months that self-pay coverage is allowed (SEBB 2018-57)

The maximum number of months that a school employee may continue SEBB benefits during an approved leave of absence, by self-paying the premium and applicable premium surcharges, will be 29 months. The 29 months a school employee may self-pay for coverage under this provision includes the total months of continuation coverage allowed under the federal Consolidated Omnibus Budget Reconciliation Act (COBRA).

Continuation coverage for dependents not eligible under the SEBB Program (SEBB 2018-58)

A dependent of a SEBB-eligible school employee who is enrolled in medical, dental, or vision under a school employee’s account on December 31, 2019 who loses eligibility because they are not an eligible dependent under the SEBB Program may enroll in medical, dental, and vision for a maximum of 36 months on a self-pay basis.

Meeting recap

The following informational items were presented to the SEB Board. To get all of the materials presented at the January 24 SEB Board meeting, view the briefing book.

  • Dave Iseminger, director of HCA’s Employees and Retirees Benefits (ERB) Division, addressed follow-up Board questions from the December 13 meeting, including:
    • Any employer with a collective bargaining agreement (CBA) signed before October 19, 2017 does not have to collect taxes for Paid Family and Medical Leave until the CBA expires.
    • Employers may need to include stipends when reporting monies paid and hours worked for unemployment insurance, depending on the purpose of the stipend.
    • Providing links for network searches and behavioral health utilization management policies for the SEBB Program’s health insurance providers.
  • Molly Christie, ERB strategic plan project manager, and Ryan Pistoresi, HCA assistant chief pharmacy officer, presented the second installment in Christie’s informational series, Pharmacy 101, about the prescription drug market and government health strategies.
  • Kim Wallace, SEBB finance manager, and Cade Walker, executive special assistant to the ERB Division director, gave a procurement update, with information on the status of fully insured medical benefits contracts, rates, timelines, and open-enrollment training.
    • Wallace also reported on the Governor’s proposed budget and how it addresses basic education health insurance funding, and presented an update on the K-12 Retiree and Disabled School Employees Risk Pool Analysis report, which was presented to the Legislature on January 17.
    • Walker also gave a legislative update, with information on which bills impact the ERB Division.
  • John Bowden, SEBB section manager, and Jerry Britcher, HCA Chief Information Officer, provided a video demonstration of the SEBB My Account online member portal.
  • Justin Hahn, ERB Washington Wellness program manager, followed up on questions from the SEB Board’s December 2018 meeting, including:
    • The return on investment for spouse participation in wellness programs and SmartHealth; and
    • The logistic challenges of combining the SmartHealth Well-being assessment with a medical provider health assessment.
  • Rob Parkman, ERB Division policy and rules coordinator, presented new policy resolutions for a future vote, including:
    • Five resolutions establishing rules for SEBB organizations that locally negotiate eligibility for school employees that do not qualify for state contribution, based on RCW 41.05.740 (6)(e).
    • Continuation coverage eligibility for school employees who lose coverage under the SEBB Program’s eligibility rules.
    • Eligibility for dependents of school employees who are already on continuation coverage through a SEBB organization on December 31, 2019, may elect coverage through the SEBB Program on a self-pay basis.

HCA will post meeting minutes on the Meetings and materials webpage after they are approved by the Board.

Coming in March

There is no SEB Board meeting scheduled for February. On March 7, 2019, the SEB Board may vote on the following resolutions:

Requirement to negotiate by group under RCW 41.05.740(6)(e) (SEBB 2019-01)

A SEBB organization that elects to locally negotiate eligibility for school employees under RCW 41.05.740(6)(e) may only negotiate by group as described below:

  • The entire SEBB organization; or
  • An entire collective bargaining unit; and/or
  • A group containing all non-represented school employees.

Anticipated work hours eligibility range under RCW 41.05.740(6)(e) (SEBB 2019-02)

A SEBB organization that elects to locally negotiate eligibility for school employees under RCW 41.05.740(6)(e) shall negotiate within the range of anticipated work hours described below:

  • No less than 180 hours per school year; and
  • No more than the threshold to meet the SEB Board’s eligibility.

SEBB benefits authorized under RCW 41.05.740 (6)(e) (SEBB 2019-03)

A SEBB organization that elects to locally negotiate eligibility for school employees under RCW 41.05.740(6)(e) must offer all of and only the following SEBB benefits to school employees and their dependents:

  • Medical;
  • Dental;
  • Vision; and
  • Basic Life and AD&D.

SEBB tier categories and premium tier ratios authorized under RCW 41.05.740(6)(e) (SEBB 2019-04)

A SEBB organization that elects to locally negotiate eligibility for school employees under RCW 41.05.740(6)(e) must offer the same tier categories and premium tier ratios as adopted in SEBB 2018-14.

Employer share requirement under RCW 41.05.740 (6)(e) (SEBB 2019-05)

A SEBB organization must contribute:

  • The same employer medical contribution (EMC), for all tiers, as if the school employee were eligible under RCW 41.05.740(6)(d);
  • 100% of the monthly premium, for all tiers, for the dental and vision plans as selected by the school employee;
  • 100% of the monthly premium for the basic life and AD&D benefits;
  • 100% of the monthly administration fee as charged by HCA; and
  • 100% of the monthly K-12 remittance fee.

SEBB continuation coverage eligibility for school employees not eligible for benefits under the SEBB Program (SEBB 2019-06)

A school employee who is enrolled in medical, dental, or vision under a group plan offered by a SEBB organization on December 31, 2019, who loses eligibility because they are not eligible under the SEBB Program, may elect to enroll in one or more of the following SEBB benefits: medical; dental; or vision coverage. These benefits will be provided for a maximum of 18 months on a self-pay basis.

SEBB continuation coverage eligibility for dependents already on a SEBB organization’s continuation coverage (SEBB 2019-07)

A dependent of a school employee who is continuing medical, dental, or vision coverage through a SEBB organization on December 31, 2019 may elect to finish out their remaining months, up to the maximum number of months authorized by COBRA for a similar event, by enrolling in a medical, dental, or vision plan offered through the SEBB Program on a self-pay basis.

SEBB Program development continues

For more information

You can find more information on the SEBB Program webpage.