Notice of School Employees Benefits Board (SEBB) Program Administrative Policy Statements

The following is a list of administrative policies published by the SEBB program. These policies are effective October 1, 2019.

You can download the complete policy statements at https://www.hca.wa.gov/employee-retiree-benefits/rules-and-policies/sebb-rules-and-policies.

Policy 11-1: Providing a notice to a school employee and a SEBB organization. To clarify the requirements of an employer-to-employee and employee-to-employer notice, as stated in RCW 41.05.009(2) and 41.05.740 (6)(d) and (e).

Policy 12-1: Determining the first day of school for SEBB organizations. This policy applies when a SEBB organization is determining the first day of school for the upcoming school year.

Policy 19-1: Termination due to loss of eligibility or enrollment error. This policy applies whenever coverage for a subscriber or a subscriber's dependent is terminated due to loss of eligibility, or because a subscriber or dependent was enrolled when they were not eligible for coverage.

Addendum 19-1A: Termination due to loss of eligibility or enrollment error: School employee and dependent of school employee.

Addendum 19-1B: Termination due to loss of eligibility or nonpayment: Self-pay subscriber and dependent of self-pay subscriber.

Policy 31-1: Verifying dependent eligibility before enrollment. This policy clarifies which documents the SEBB program considers valid for dependent verification and identifies which accounts are included in the dependent verification process. Although some subscriber accounts are not included in the process, the SEBB program reserves the right to review a dependent's eligibility at any time.

Policy 31-2: Use of premium surcharge help sheet and spousal plan calculator tools. This policy provides direction when a SEBB program subscriber enrolled in SEBB medical is determining if a premium surcharge will be applied for a spouse or state registered domestic partner enrolled in SEBB medical.

Policy 33-1: Verifying legal union's residency status. This policy clarifies which documents the SEBB program considers valid for establishing state residency for subscribers who are in a legal union as defined in RCW 26.04.260 that is substantially equivalent to marriage in Washington state.

Policy 36-1: Certifying eligibility for a dependent child with a disability who is age 26 or older. This policy applies whenever a subscriber requests to enroll or continue enrollment for a dependent child with a disability who is age twenty-six or older on their SEBB program subscriber account.

Policy 37-1: Certifying eligibility for an extended dependent child. This policy applies when a subscriber submits the required forms to enroll an extended dependent child in the subscriber's SEBB benefits.

Policy 56-1: Continuation coverage reinstatement for subscribers with mental or physical impairment or incapacitation. This policy applies whenever a subscriber (or another party acting on behalf of the subscriber) requests reinstatement of continuation coverage due to nonpayment of premiums, or applicable premium surcharges, for reason of mental or physical impairment or incapacitation.

This policy establishes the methodology the SEBB program will use to make a determination of mental or physical impairment or incapacitation for the purpose of reinstatement of coverage terminated due to nonpayment of premiums, or applicable premium surcharges.

This policy provides timing requirements for requesting reinstatement due to nonpayment of premiums, or applicable premium surcharges, for reason of mental or physical impairment or incapacity.

Policy 56-2: Election period tolling for applicants with mental or physical impairment or incapacitation. This policy applies whenever an applicant (or another party acting on behalf of the applicant) requests tolling of the continuation coverage, new employee eligibility, annual open enrollment, or special open enrollment election period, for reason of mental or physical impairment or incapacitation.

This policy establishes the methodology that the SEBB program will use to make a determination of mental or physical impairment or incapacitation for the purpose of tolling the election period of continuation coverage, new employee eligibility, annual open enrollment, or special open enrollment.

This policy provides timing requirements to request tolling of the election period for reason of mental or physical impairment or incapacity.

Policy 60-1: Required appeals related documents when the SEBB program conducts a brief adjudicative proceeding. This policy clarifies what particular documents are required from a SEBB organization or third-party administrator when the SEBB program is conducting a brief adjudicative proceeding at the request of one of its school employees or subscribers.

Policy 91-1: Requesting a reasonable alternative for completing wellness incentive program requirements or avoiding the tobacco use premium surcharge. This policy applies when a subscriber who is eligible to participate in the SEBB wellness incentive program is seeking a reasonable alternative to a wellness incentive program requirement in order to receive a wellness incentive.

This policy also applies when an enrollee on a SEBB medical plan is seeking a reasonable alternative so that a subscriber can avoid paying the tobacco use premium surcharge as described in WAC 182-30-050 (1)(c)(iii).

Policy 91-2: Tobacco as it relates to religious or ceremonial use. This policy applies whenever a SEBB program subscriber is attesting to an enrolled member's tobacco use status. The purpose of the policy is to clarify the exception for the religious or ceremonial use of tobacco.

Policy 91-3: Washington wellness worksite designation program incentive requirements. This policy provides a set of requirements for SEBB organizations to use when offering wellness incentives under the Washington wellness worksite designation program.

To receive a hard copy of the policy statements, contact Rob Parkman, P.O. Box 42684, [Olympia,] WA 98504-2684 or 360-725-0883.