SEBB Insurance Resources

Breaking news (01/27/2020)  The SEBB adopted two policies today that were meant to clarify eligibility rules; both policies are retroactive to January 1, 2020.  The first policy directs districts to include paid time off (including paid holiday hours) in eligibility determinations regarding the 630 hours.  This will ensure that employees who are scheduled to work 630 hours in a year would not lose benefits if they need to take a sick day.   In addition, the board adopted a policy that clarified how an employee who is returning from approved leave without pay can qualify for SEBB benefits upon their return.  This will create fair rules between mid-year hires and returning/existing employees as well as ensure consistency for those returning from leave without pay no matter what time of year they need to take that leave.

Policy Resolution SEBB 2020-01 Inclusion of Paid Hours

Effective January 1, 2020, 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.

Policy Resolution SEBB 2020-02 Benefits Eligibility After Returning to Work

Effective January 1, 2020, school employees who return from approved leave without pay will maintain or establish eligibility for the employer contribution if their work schedule, had it been in effect at the start of the school year, would have resulted in the employee being anticipated to work the minimum hours to meet SEBB eligibility in the school year. A school employee who regains eligibility under this policy establishes eligibility for the employer contribution towards SEBB benefits as of the date they returned from approved leave, and coverage will become effective the first day of the month following the employee’s return to work.

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Breaking news (1/9/2020)

This was just released by Health Care Authority.  It explains the SEBB appeals process and gives a phone number to call to check on the status of an appeal or to request an expedited appeal if there is an urgent medical issue:   https://www.hca.wa.gov/sebb-program-addressing-appeals

There is more detail on the website, but here is the specific part regarding the phone line:

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.

There have been many frustrated members who have been looking for any kind of update on their appeal.  Hopefully, this phone line and the initial mailing of appeal resolution letters will help to bring some peace of mind to those who are frustrated with this transition.

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The Legislature has approved and funded a new health care system for K-12 school employees that begins in January 2020. The new School Employees Benefits Board (SEBB) program will replace the existing health insurance negotiated locally in each school district. That means all K-12 public school employees will have a new insurance plan beginning January 1.

Summary of Benefits and Coverage – Coverage, limitations, preauthorizations:    https://www.hca.wa.gov/employee-retiree-benefits/school-employees/benefits-and-coverage-plan#what-is-sbc

Provider Directories: https://www.hca.wa.gov/employee-retiree-benefits/school-employees/find-provider

NEED HELP?!!  WEA Health Care Hotline 1-855-668-5039 (Monday-Friday 7:30 am – 5:00 pm)

Appeals must be filed within 30 days of the denial notification.  https://www.hca.wa.gov/about-hca/file-appeal-sebb#who-can-appeal    1-800-351-6827