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FAQs for school administrators

The following frequently asked questions (FAQs) help you understand the SEBB Program and how it affects your school district, educational service district, or charter school.

Questions about corona virus and eligibility during school closures? See Information about novel corona virus (COVID-19).

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 employees pay for their 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.

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.

School districts currently offer many types of accident policies, and it is not possible to determine by name alone whether the policies conflict with the SEBB Program’s authority. It appears that accident insurance policies likely conflict with the SEBB Program’s authority, but more information is needed about the exact coverage to make a final determination.  Examples of accident insurance brought to HCA’s attention have primarily included income replacement, which would conflict with the SEBB Program’s disability insurance benefit authority, or accident coverage that would conflict with the SEBB Program's accidental death and dismemberment benefit authority. Review of  accident insurance plan policies is necessary to ensure they don't conflict with the SEBB Program’s authority. This review began on December 1, 2019, and each year thereafter, when SEBB organizations that elect to offer optional benefits submit their reports to HCA describing any optional benefits they are offering to school employees.

 

The SEB Board has the authority to offer these kinds of insurance products and can consider offering them in the future. However, the portfolio of medical benefits offered to school employees in 2020 is comprehensive and already includes coverage for conditions such as cancer, critical illness, and emergency transportation. Members can select from an array of plan choices to meet different levels of coverage needs. If school districts offered these types of plans in addition to the SEBB medical plans, it would affect the state’s negotiation position when setting rates and would reduce the ability to secure the best rates possible on behalf of members.

Employees are required to provide evidence of a dependent’s eligibility within the SEBB Program’s timelines. Benefits administrators verify dependents’ eligibility for coverage.

The makeup and structure of the coalition is determined by unions that represent school employees after careful research and consideration. The coalition bargaining team currently includes representatives of: American Federation of Teachers Washington; Association of Washington Principals; Operating Engineers; Public School Employees of Washington; Service Employees International Union; Teamsters; and Washington Education Association. The spokesperson for the coalition is Shawn Lewis, with WEA.

For the state, representatives from the Office of Financial Management (OFM) directly negotiate with a coalition of school employee unions, with staff support from the Health Care Authority (HCA).

The Health Care Authority (HCA) administers the continuation coverage for COBRA and unpaid leave starting January 1, 2020. At that time, once a SEBB organization notifies the SEBB Program through SEBB My Account that a school employee has lost eligibility for SEBB benefits, HCA will mail a SEBB Continuation Coverage Election Notice booklet to the subscriber and/or any enrolled dependent who lost SEBB coverage. The subscriber and/or dependents will work directly with HCA to enroll in and pay for benefits under SEBB Continuation Coverage. They cannot enroll in continuation coverage through SEBB My Account. A paper enrollment form will be included in the SEBB Continuation Coverage Election Notice. See SEBB Continuation Coverage for more information.

RCW 41.56.500 (3) requires that the state bargain for all school employees with a coalition representing school employee unions across the state over funding for health care benefits governed by the SEBB program. By law, the purpose of bargaining is to determine the dollar amount to be contributed on behalf of each employee for health care benefits. The bargaining is not intended to restrict the type, quality, or specific benefit offerings that the SEBB Program offers.

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