WSR 20-16-064
PERMANENT RULES
HEALTH CARE AUTHORITY
(School Employees Benefits Board)
[Admin #2020-01—Filed July 28, 2020, 4:42 p.m., effective August 28, 2020]
Effective Date of Rule: Thirty-one days after filing.
Purpose: The purpose is to amend WAC 182-30-130 to support the school employees benefits board (SEBB) program.
Implement SEBB policy resolutions and make technical amendments: Amended WAC 182-31-040 to make technical corrections for readability and update references as needed for structural changes. Amended subsection (3) to include all hours that a school employee receives compensation from their SEBB organization for a paid holiday or while on approved leave to the hours that count while determining eligibility for SEBB program benefits. Amended subsection (6) to add a new method for a school employee who returns from an approved leave without pay to maintain or establish eligibility. Amended subsection (7) to clarify what benefits are available and the date that they will begin and to add an exception to when benefits are earned in the month of August.
Citation of Rules Affected by this Order: Amending WAC 182-31-040.
Other Authority: SEBB Policy Resolutions 2020-01, 2020-02, and 2020-05.
Adopted under notice filed as WSR 20-13-072 on June 16, 2020.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: July 28, 2020.
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION(Amending WSR 19-14-093, filed 7/1/19, effective 8/1/19)
WAC 182-31-040How do school employees establish eligibility for the employer contribution toward school employees benefits board (SEBB) benefits and when do SEBB benefits ((coverage)) begin?
(1) Eligibility shall be determined solely by the criteria that most closely describes the school employee's work circumstance.
(2) School employee eligibility criteria:
(a) A school employee is eligible for the employer contribution toward((s)) school employees benefits board (SEBB) benefits if they are anticipated to work at least six hundred thirty hours per school year. The eligibility effective date for a school employee eligible under this subsection shall be determined as follows:
(i) If the school employee's first day of work is on or after September 1st but not later than the first day of school for the current school year as established by the SEBB organization, they are eligible for the employer contribution on the first day of work; or
(ii) If the school employee's first day of work is at any other time during the school year, they are eligible for the employer contribution on that day.
(b) A school employee who is not anticipated to work at least six hundred thirty hours in the school year becomes eligible for the employer contribution toward((s)) SEBB benefits on the date their work pattern is revised in such a way that they are now anticipated to work six hundred thirty hours in the school year.
(c) A school employee who is not anticipated to work at least six hundred thirty hours in the school year becomes eligible for the employer contribution toward((s)) SEBB benefits on the date they actually worked six hundred thirty hours in the school year.
(d) A school employee who is not anticipated to work six hundred thirty hours within the school year because of the time of year they are hired but is anticipated to work at least six hundred thirty hours the next school year, establishes eligibility for the employer contribution toward SEBB benefits as of their first working day if they are:
(i) A nine to ten month school employee anticipated to be compensated for at least seventeen and one-half hours a week in six of the last eight weeks counting backwards from the week that contains the last day of school; or
(ii) A twelve month school employee anticipated to be compensated for at least seventeen and one-half hours a week in six of the last eight weeks counting backwards from the week that contains August 31st, the last day of the school year.
(3) All hours worked by an employee in their capacity as a school employee must be included in the calculation of hours for determining eligibility. All hours for which a school employee receives compensation from a SEBB organization during an approved leave (e.g., sick leave, personal leave, bereavement leave) or a paid holiday must be included when determining how many hours a school employee is anticipated to work, or did work, in the school year.
(4) A school employee may establish eligibility for the employer contribution toward SEBB benefits by stacking of hours from multiple positions within one SEBB organization. A school employee may not gain eligibility by stacking of hours from multiple SEBB organizations.
(5) A school employee is presumed eligible for the employer contribution at the start of the school year, as described in subsection (2)(a) of this section, if they:
(a) Worked at least six hundred thirty hours in each of previous two school years; and
(b) Are returning to the same type of position (teacher, paraeducator, food service worker, custodian, etc.) or combination of positions with the same SEBB organization.
Note: | A SEBB organization rebuts this presumption by notifying the school employee, in writing, of the specific reasons why the school employee is not anticipated to work at least six hundred thirty hours in the current school year and how to appeal the eligibility determination. |
(6) A school employee who returns from approved leave without pay will maintain or establish eligibility for the employer contribution toward SEBB benefits if their work schedule, had it been in effect at the start of the school year, would have resulted in the school employee being anticipated to work the minimum hours to meet SEBB eligibility for the employer contribution in the school year. A school employee who regains eligibility under this subsection establishes eligibility for the employer contribution toward SEBB benefits as of the date they returned from approved leave without pay.
(7) When SEBB benefits begin:
(a) For a school employee who establishes eligibility under subsection (2)(a)(i) of this section ((SEBB benefits)), medical, dental, vision, basic life insurance, basic accidental death and dismemberment (AD&D) insurance, basic long-term disability (LTD) insurance, and if eligible, benefits under the salary reduction plan begin on the first day of work for the new school year. Supplemental life insurance, supplemental AD&D insurance, and supplemental LTD insurance begin on the first day of the month following the date the contracted vendor receives the required form or approves the enrollment.
(b) For a school employee who establishes eligibility under subsection (2)(a)(ii), (b), (c), ((or)) (d), or (6) of this section, ((SEBB insurance coverage))medical, dental, vision, basic life insurance, basic AD&D insurance, basic LTD insurance, and if eligible, benefits under the salary reduction plan begin((s)) on the first day of the month following the date the school employee becomes eligible for the employer contribution toward((s)) SEBB benefits. Supplemental life insurance, supplemental AD&D insurance, and supplemental LTD insurance begin on the first day of the month following the date the contracted vendor receives the required form or approves the enrollment.
Exception: | When a school employee establishes eligibility for the employer contribution toward SEBB benefits as described under subsection (2)(b) or (c), or (6) of this section, at any time in the month of August, SEBB benefits begin on September 1st only if the school employee is also determined to be eligible for the employer contribution toward SEBB benefits for the school year that begins on September 1st. |
(((7)))(8) If the school employee is not eligible under subsections (1) through (((5)))(6) of this section, they may be eligible for SEBB benefits if their SEBB organization is engaging in local negotiations regarding eligibility for school employees as described in WAC 182-30-130.