Forms and publications
Access manuals, forms, enrollment guides, and other resources to support benefits administrators (BAs) with the administration of School Employees Benefits Board (SEBB) benefits.
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Below you will find manuals, user guides, and resources related to the SEBB My Account, the Benefits 24/7 online enrollment system, accounting, correcting SEBB organization errors, appeals, and HCA Support. Employee enrollment resources, such as guides and forms, certification forms for dependents, and many other resources are also available to download.
When printing forms to share with employees, also provide the SEBB nondiscrimination statement and language access notice.
Benefits 24/7
- Benefits 24/7 manuals and resources
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The Benefits 24/7 online enrollment system will not be available until launch, which is anticipated to occur in January 2024.
The following resources are for benefits administrators (BAs).
- Benefits 24/7 (Login is not available until launch in January 2024)
- Benefits 24/7 manuals
- Eligibility file specifications
- Lower limit calendar
- SEBB Policy 19-1A: Termination due to loss of eligibility or enrollment error
Learn more on the Administering SEBB in Benefits 24/7 webpage.
Accounting
- Accounting manuals and resources
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The accounting manual contains the current year's invoicing dates along with other accounting-related guidance.
- Accounting training manual 2023 | 2024
- SEBB Program monthly billing cycle
These resources can also be found on the Accounting webpage.
- Supplemental benefits billing resources
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Life and accidental death and dismemberment (AD&D) insurance
MetLife manages billing and processes enrollment and claims for SEBB life and accidental death and dismemberment insurance.
- Life and AD&D administration manual
- SEBB list bill process and guidelines
- SEBB paper list bill example
- SEBB bill record layout
- SEBB remit record layout
- Enrollment and supplemental billing guide for new employers joining SEBB
Long-term disability (LTD) insurance
The Standard manages billing and processes claims for SEBB long-term disability insurance (LTD).
- SEBB LTD Administration Manual
- LTD employer portal
- Portal authorization instructions
- LTD premium calculation
- Sample invoice
- Payment letter
Flexible Spending Arrangements (FSAs) and the Dependent Care Assistance Program (DCAP)
Navia manages billing and processes claims for the SEBB Program's Medical Flexible Spending Arrangement (FSA), Limited Purpose FSA, and the Dependent Care Assistance Program.
- Access the Navia Employer Portal
These resources can also be found on the Accounting webpage.
Correcting SEBB organization errors
- Error correction resources
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- SEBB Error Correction Guidelines
- Sample correction/recourse letters
Learn more on the Correcting SEBB organization errors webpage.
Appeals
- Appeals form and resources
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- SEBB Appeals process map
- Employee Request for Review/Notice of Appeal form
- Authorization for Release of Information
Learn more on the Appeals process webpage.
HCA Support
HCA Support is a secure, web-based correspondence program that allows you to send documents and communicate directly with O&T, SEBB Accounting, and other departments within the SEBB Program by using the designated tile named, "Benefits administrator inquiry".
- HCA Support resources
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It's important that BAs use the designated tile named, "Benefits administrator inquiry". Using the "General Support" tile will lead to a delayed response, as your inquiry will be initially routed to units at HCA that are outside of O&T.
Employees and dependents
- Enrollment guide, forms, and resources
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Employees are encouraged to complete enrollment online using SEBB My Account. However, the forms provided below can also be used for employee and dependent enrollment.
- School Employee Enrollment Guide 2023 | 2024
- The following school employee enrollment and change forms can be used by eligible employees of SEBB organizations:
- School Employee Enrollment form 2023 | 2024
- Use the 2023 enrollment form if benefits are effective during the 2023 plan year.
- Use the 2024 enrollment form if benefits are effective during the 2024 plan year,
- School Employee Change form 2023 | 2024
- Use the 2023 change form to make changes that are effective during the 2023 plan year due to a special open enrollment (SOE).
- Use the 2024 change form to make changes during annual open enrollment (effective January 1, 2024) and to make changes that are effective during the 2024 plan year due to an SOE.
- School Employee Enrollment form 2023 | 2024
- The following school employee enrollment/change form can be used by employees of SEBB employer groups who contract with the SEBB Program to offer medical-only benefits to their eligible employees:
The following forms can be used for employee and dependent enrollment in employee-paid long-term disability insurance, supplemental life and supplemental accidental death and dismemberment (AD&D) insurance and to elect participation in a flexible spending arrangement (FSA) or the Dependent Care Assistance Program (DCAP).
- LTD Enrollment/Change form
- MetLife Enrollment/Change form (for electing supplemental life and AD&D insurance and adding beneficiaries)
- MetLife Beneficiary Designation form (for adding or updating beneficiaries only)
- FSA and DCAP Midyear Enrollment form 2023 | 2024
Learn more on the Employee enrollment webpage.
- Dependent forms and resources
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- Certification of a Child with a Disability form
- Extended Dependent Certification form
- Declaration of Tax Status form 2023 | 2024
- SEBB Policy 31-1: Verifying dependent eligibility before enrollment
- SEBB Policy 33-1: Additional verification requirements for partners of a legal union
- SEBB Policy 36-1: Certifying eligibility for a dependent child with a disability who is age 26 or older
- SEBB Policy 37-1: Certifying eligibility for an extended dependent child
Learn more on the Dependents webpage.
- Premium surcharges
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- Premium Surcharge Attestation Help Sheet 2023 (Help Sheet information for 2024 can be found in the 2024 Premium Surcharge Attestation Change form.)
- Premium Surcharge Attestation Change form 2023 | 2024
- Spousal Plan Calculator (print version) 2023 | 2024
- Spousal Plan Calculator (interactive tool) 2023 | 2024
Learn more on the Premium surcharges webpage.
Life and accidental death and dismemberment (AD&D) insurance
- Life and AD&D forms and resources
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- Life and AD&D Administration Manual
- Certificate of Coverage (COC) (at least 630 hours)
- Certificate of Coverage (COC) (less than 630 hours)
- MetLife Advantages
- MetLife's MyBenefits portal
- Employees can use the MyBenefits portal to add/update beneficiaries and elect/change supplemental coverages.
- MetLife Enrollment/Change form
- Beneficiary Designation form
- Cancellation of supplemental life and AD&D insurance form
- Notification of enrollment extension form for supplemental life
- Privacy notice
Learn more on the Life and AD&D webpage.
Long-term disability (LTD) insurance
- LTD forms and resources
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- LTD Administration Manual
- LTD plan booklet
- Enrollment/Change form
- Evidence of Insurability
- Claim packet
- LTD error or discrepancy correction form
Learn more on the LTD webpage.
Flexible Spending Arrangements (FSAs) and Dependent Care Assistance Program (DCAP)
- FSA and DCAP forms and resources
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- Midyear Enrollment form 2023 | 2024
- FSA and DCAP Claim form 2023
- Change in Status form 2023
- School Employment Transfer form 2023
- FSA Termination form 2023
- Find additional forms and documents on Navia's website.
Learn more on the FSA and DCAP webpage.
Additional forms and resources
- Apple Health (Medicaid)
- Dual enrollment
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Learn more on the Employee enrollment webpage
- Health Savings Account (HSA)
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- Employee Authorization for Payroll Deduction for HSA 2023 | 2024
- Beneficiary Designation
- Find additional HSA forms and documents on HealthEquity's website.
- Premium payments
SEBB Continuation Coverage
- COBRA and Unpaid Leave resources
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- Initial notice of COBRA and Continuation Coverage rights 2023
- Continuation Coverage Election Notice 2023
Learn more on the COBRA and Unpaid Leave webpages.
PEBB retiree insurance
- PEBB retiree insurance resources
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- Retiree Enrollment Guide 2023 | 2024
- PEBB retiree health insurance checklist
Learn more on the Retirees website.