SEB Board passes resolutions on effective date of coverage and self-insured medical plans

Fri, 06/15/2018

On June 13, 2018, the School Employees Benefits Board (SEB Board) voted on a policy resolution to establish the effective date of coverage for school employees eligible for the employer contribution toward SEBB benefits.

The SEB Board also voted on benefit resolutions to offer four self-insured plans under the state’s Uniform Medical Plan (UMP).

These resolutions will apply to eligible employees of school districts, educational service districts (ESDs), and charter schools who will receive their health insurance benefits through the SEBB Program starting January 1, 2020. 

Policy resolution

The following policy resolution was approved by the SEB Board.

Effective date of coverage for school employees eligible for the employer contribution (SEBB 2018-12) 

For September each year, a school employee who is establishing eligibility for the employer contribution toward SEBB benefits, and whose first day of work is on or after September 1 but not later than the first day of school for the current school year as established by the SEBB organization, the effective date of coverage is the first day of work.

For a school employee who is establishing eligibility and whose first day of work is at any other time during the school year, the effective date of coverage is the first day of the month following the day the school employee establishes eligibility for the employer contribution toward SEBB benefits.

Benefit resolutions

The following benefit resolutions were approved by the SEB Board.

Self-insured plan offering (SEBB 2018-20)

Beginning January 1, 2020, and subject to financing decisions, the SEBB Program will offer a self-insured plan with the same covered services and exclusions, same provider networks, and same clinical policies as the Uniform Medical Plan Classic in place for plan year 2020 under the PEBB Program. The cost shares (deductible, out-of-pocket maximums, coinsurance for services, etc.) will be the same as the UMP Classic under the PEBB Program.

Second self-insured plan offering (SEBB 2018-21)

Beginning January 1, 2020, and subject to final financing decisions, the SEBB Program will offer a self-insured plan with the same covered services and exclusions, same provider networks, and same clinical policies as the Uniform Medical Plan Classic in place for plan year 2020 under the PEBB Program. The cost shares (deductible, out-of-pocket maximums, coinsurance for services, etc.) will be the same as the UMP Classic under the PEBB Program, except for the following:

  • Annual deductible (medical): $750/$2,250 (single/family)
  • Annual deductible (drug): $250/$750 (single/family)
  • Out-of-pocket maximum (medical): $3,500/$7,000 (single/family)
  • Coinsurances: 20%/80% (member/plan)

Third self-insured plan offering (SEBB 2018-22)

Beginning January 1, 2020, and subject to financing decisions, the SEBB Program will offer a self-insured plan with the same covered services and exclusions, same provider networks, and same clinical policies as the Uniform Medical Plan Consumer-Directed Health Plan (CDHP) in place for plan year 2020 under the PEBB Program. The cost shares (deductible, out-of-pocket maximums, coinsurance for services, etc.) will be the same as the UMP CDHP under the PEBB Program.

Fourth self-insured plan offering (SEBB 2018-23)

Beginning January 1, 2020, and subject to final financing decisions, the SEBB Program will offer a self-insured plan with the same covered services and exclusions, same provider networks (either or both of the Puget Sound High Value Network [PSHVN] and UW Medicine Accountable Care Network [UW Medicine ACN]), and same clinical policies as the Uniform Medical Plan Plus in place for plan year 2020 under the PEBB Program. The cost shares (deductible, out-of-pocket maximums, coinsurance for services, etc.) will be the same as the UMP Plus.

The SEB Board has the authority to customize the SEBB Program’s self-insured plans for plan year 2020, by amending resolutions 2018-20 through 2018-23 at an upcoming meeting, in the following ways:

  • Modifying dollar amounts and limits on member cost sharing, such as deductibles, copays, coinsurance, maximum out-of-pocket costs, and out-of-network costs.
  • Increasing or decreasing services that have an annual visit limit.
  • Changing each plan’s list of covered and excluded services.

See the SEB Board Meetings and materials page for more information about these resolutions.

Meeting recap

The following items were also presented to the SEB Board for informational purposes as part of the June 13 agenda.

  • Employees and Retirees Benefits (ERB) Division Director Dave Iseminger addressed questions posed by the Board at its May 30 meeting regarding the UMP. Iseminger’s update included information on:
    • UMP’s results from the 2016 and 2017 Consumer Assessment of Healthcare Providers and Systems (CAHPS) member surveys.
    • Options under consideration for the pharmacy benefit transition period experience when members join a SEBB self-insured plan.
  • SEBB Section Manager John Bowden updated the Board on the SEBB Program’s project timeline leading up to the January 1, 2020 implementation.
  • SEBB Procurement and Account Manager Lauren Johnston provided an update on the group vision plan procurement. Health Care Authority (HCA) released a Request for Information on March 27, 2018, and had 10 respondents with widespread provider availability throughout the state, though no ophthalmologists or optometrists were available in Garfield or Columbia counties. An upcoming Request for Proposal (RFP) will ask group vision plan bidders to submit different plan designs and rates for HCA to evaluate. The SEB Board will be asked to vote on vision plan and fully insured medical design resolutions this fall, and decide whether to keep vision benefits embedded in the medical plans’ benefits, or to offer separate group vision plans.
  • ERB Benefit Strategy and Design Section Manager Marcia Peterson, Portfolio Management and Monitoring Account Manager Shawna Lang, and Financial Services Deputy Section Manager Kim Wallace presented information on self-insured medical plans before the SEB Board voted on benefit resolutions regarding the SEBB Program’s self-insured plan offerings.
  • Public comments were made at the conclusion of the meeting. The HCA will post meeting minutes on the Meetings and materials page.

To get all of the materials presented at the June 13 SEB Board meeting, view the briefing book.

Next steps

On July 30, 2018, the SEB Board may vote on resolutions regarding:

  • When the employer contribution for SEBB benefits ends.
  • SEBB eligibility for the employer contribution based on:
    • A revision to the school employee’s anticipated work pattern.
    • Actual hours worked.
    • Stacking of hours.
  • The requirement to provide evidence of a dependent’s eligibility to enroll the dependent in SEBB benefits.

Benefit procurement work continues. HCA released the competitive solicitation for fully insured medical plans on June 8, and will release the RFP for vision plans later in June.

For more information

You can find more information on the SEBB Program page.