SEBB Program addressing appeals

Wed, 01/08/2020

If you submitted an appeal to the School Employees Benefits Board (SEBB) Program, please be assured that we are working through them as quickly as possible. If approved, coverage will be effective back to January 1, 2020.

This week, the Health Care Authority (HCA) will begin mailing letters to school employees whose appeals have been processed. The letter will state either:

  • The appeal was approved; OR
  • Information about next steps in the appeals process.

I filed an appeal to change my dental plan from DeltaCare, what next?

All plan change request appeals related to the letter Delta Dental sent in mid-December will be approved. HCA and Delta Dental will honor the request to switch from DeltaCare to Uniform Dental Plan. You will soon receive a letter confirming the approval with coverage effective back to January 1, 2020.

My dependent was denied and I submitted an appeal, what now?

If you included documents with your appeal that met the requirements to verify the requested dependent’s eligibility, no further action is needed. You will soon receive a letter confirming your dependent’s enrollment with coverage effective back to January 1, 2020.

If your appeal is denied, you will receive a letter with information about the next step in the appeals process.

How to check if your appeal has been received or request an expedited appeal for an urgent medical need

Effective immediately, you can call 1-800-200-1004 (and select menu option “7”) 8 a.m. to 4:30 p.m. Monday through Friday to:

  • Learn whether your appeal has been received.
  • Request to expedite review of your appeal if you or a dependent have an urgent medical need.

Please keep in mind that call wait times may be longer than usual due to the high volume of appeals. Until all appeals are logged in, our records may not show your appeal as being received yet. Our goal is to process all approved appeals that do not need additional action by a school employee by mid-January.  Please do not resubmit your appeal until all appeals have been processed.

If you feel your life, health, or safety is at risk you should seek care immediately.

An urgent medical need for physical health, mental health, and substance use disorder services may include:

  • Urgent care or emergency care visits.
  • Hospital admissions.
  • A surgery or procedure needed within the next 10 calendar days.
  • A medication refill needed within the next 10 calendar days.

When you call, tell the customer service representative that you or your dependent have an urgent medical need requiring an expedited appeal decision. An HCA account manager will contact you by phone or email (generally the same day but within one business day) and work with you until a resolution on the appeal is reached. If the situation occurs outside of HCA business hours, contact HCA the following business day.