If you are displaced or affected by wildfire, all Washington Apple Health and PEBB/SEBB medical plans are allowing prescription refills before the refill date.
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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).
Yes. For example, if an employee resigns in the middle of the month, the district covers them through the end of that month.
Yes. To avoid the tobacco use premium surcharge, employees must attest that they and their dependents do not use tobacco. For more on this, visit the Tobacco use surcharge webpage.
No. Medicare is not employer-based group medical coverage, so the premium surcharge does not apply.
No. They can only waive SEBB medical coverage if they are enrolled in other employer-based group medical insurance, a TRICARE plan, or Medicare. Retirement policies are not employer-based, so they do not qualify.
Employees who want to waive medical coverage can use either SEBB My Account or paper forms. If they waive medical coverage within the SEBB Program timelines, they will not be automatically enrolled into a medical plan. If they do not waive medical coverage or do not enroll in a plan within the SEBB Program’s timelines, they will default into UMP Achieve 1, and will be charged the tobacco use premium surcharge.
Yes. Employees can only waive medical coverage. They cannot waive dental, vision, or other benefits. The funding rate calculation assumes a certain percentage of employees will waive medical coverage, which reduces the average amount of employer funding needed per employee.
Yes. The employee’s SEBB benefits would begin June 1 and run through August 31.
No. They retain coverage until the end of the school year. Their premiums will not change, unless they have a special open enrollment event and change their coverage.
Employers will continue to pay the full employer contribution for employees who go on approved leave without pay if they have already worked 630 hours during the school year or if they are on approved FMLA.
If the school employee has not worked 630 hours and the employer no longer anticipates the school employee will work 630 hours during the school year, the school employee is no longer eligible for the employer contribution toward SEBB benefits.
When the school employee returns to work after their unpaid leave, the employer will determine whether the employee is eligible for the employer contribution toward SEBB benefits. Employees who return from approved leave without pay will establish eligibility for the employer contribution if their 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.
Yes. If they cover each other, the spouse’s or state-registered domestic partner’s primary coverage would be through the PEBB Program and the secondary coverage would be through the SEBB Program. The school employee's primary coverage would be through the SEBB Program and their secondary coverage would be through the PEBB Program. In this scenario, the couple would not incur the $50 spouse or state-registered domestic partner coverage premium surcharge in addition to their monthly premiums.
However, if the spouse or state-registered domestic partner waives PEBB medical coverage and enrolls on the school employee's account (or vice versa), they would incur the $50 spouse or state-registered domestic partner coverage premium surcharge in addition to their monthly premiums.