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 15, 2020. 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. 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 11-3: Correcting school employees benefits board organization and contracted vendor enrollment errors. This policy clarifies the requirements placed on a SEBB organization or contracted vendor when they correct their own enrollment errors as described in WAC 182-30-060.

Policy 19-1: Termination due to loss of eligibility. 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.

Addendum 19-1B: Termination due to loss of eligibility or non-payment: 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 33-1: Verifying legal union's residency status. This policy sets forth special criteria, documentation criteria, and limitations for two persons in Washington state who have a legal union, other than a marriage, that was (1) validly formed in another state or jurisdiction; (2) provides substantially the same rights, benefits, and responsibilities as a marriage, and (3) does not meet the definition of a domestic partnership in RCW 26.60.030.

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 program health plan coverage.

Policy 45-2: Special open enrollment (SOE). This policy applies whenever a subscriber requests an enrollment change or election change outside of the SEBB program annual open enrollment period.

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 that 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, regained 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 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 as described in WAC 182-31-130.

This policy also applies when an enrollee on a SEBB program 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).

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

Policy 93-2: SEBB program payment plans. This policy describes the process the health care authority will use when authorizing a payment plan request for a continuation coverage or a non-medicare retiree account from a subscriber or a subscriber's legal representative.