Current through Register Vol. 24-18, September 15, 2024
School employees benefits board (SEBB) medical, dental, and
vision coverage is limited to a single enrollment per individual as described
in subsections (1) through (5) of this section. Effective January 1, 2022,
individuals are limited to a single enrollment in medical, dental, and vision
plans in either the SEBB program or public employees benefits board (PEBB)
program as described in subsection (6) of this section.
(1) An individual who has more than one
source of eligibility for enrollment in SEBB medical, SEBB dental, and SEBB
vision coverage (called "dual eligibility") is limited to one
enrollment.
(2) An eligible school
employee may waive SEBB medical and enroll as a dependent under the SEBB
medical plan of their spouse, state registered domestic partner, or parent as
described in WAC
182-31-080.
(3) A dependent enrolled in SEBB medical,
SEBB dental, or SEBB vision who becomes eligible for SEBB benefits as a school
employee must elect to enroll in SEBB benefits as described in WAC
182-30-080(1).
This includes making an election to enroll in or waive enrollment in SEBB
medical as described in WAC
182-31-080(1)(a).
(a) If the school employee does not waive
enrollment in SEBB medical, the school employee is not eligible to remain
enrolled in their spouse's, state registered domestic partner's, or parent's
SEBB medical as a dependent. If the school employee's spouse, state registered
domestic partner, or parent does not take action to remove the school employee
(who is enrolled as a dependent) from their subscriber account, the SEBB
program will automatically disenroll the school employee's enrollment as a
dependent the last day of the month before the school employee's enrollment in
SEBB benefits begins as described in WAC
182-31-040.
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Exception:
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An enrolled dependent who becomes newly eligible, at
the start of the school year, for SEBB benefits as a school employee could be
dual-enrolled in SEBB medical, dental, and vision for one month. This exception
is only allowed for the first month the dependent is enrolled as a school
employee.
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(b)
If the school employee elects to waive their enrollment in SEBB medical, the
school employee will remain enrolled in SEBB medical under their spouse's,
state registered domestic partner's, or parent's SEBB medical as a
dependent.
(4) A child
who is eligible for SEBB medical, SEBB dental, and SEBB vision under two
subscribers may be enrolled under both subscribers but is limited to a single
enrollment in SEBB medical, a single enrollment in SEBB dental, and a single
enrollment in SEBB vision.
(5) When
a school employee is eligible for the employer contribution toward SEBB
benefits due to employment in more than one SEBB organization the following
provisions apply:
(a) When a school employee
is eligible for the employer contribution during a school year under WAC
182-31-040
and
182-30-130
the SEBB organization that has determined the school employee eligible under
WAC
182-31-040
must make the employer contribution;
(b) If the school employee is eligible for
the employer contribution under WAC
182-31-040
at two different SEBB organizations, the school employee must choose to enroll
under only one SEBB organization;
(c) If the school employee is eligible for
the employer contribution under WAC
182-30-130
at two different SEBB organizations, the school employee must choose to enroll
under only one SEBB organization;
(d) If the school employee loses eligibility
under one SEBB organization, they must notify their other SEBB organization no
later than 60 days from the date of loss of the first SEBB benefits in order to
transfer coverage;
(e) The school
employee's elections remain the same when a school employee transfers their
enrollment under one SEBB organization to another SEBB organization without a
break in SEBB benefits for one month or more, as described in (d) of this
subsection.
(6) An
individual who has more than one source of eligibility for enrollment in the
SEBB and PEBB programs is limited to a single enrollment in medical, dental,
and vision plans in either the SEBB or PEBB program. A school employee must
elect to enroll in SEBB benefits as described in WAC
182-30-080,
waive enrollment as described in WAC
182-31-080,
or remove eligible dependents as described in WAC
182-31-150.
If the school employee takes no action to resolve the dual enrollment, the SEBB
program or the PEBB program will automatically enroll or automatically
disenroll the individual as described in (c) through (g) of this subsection.
(a) An eligible school employee may waive
enrollment in SEBB medical to enroll in PEBB medical only if they are enrolled
in PEBB dental as described in WAC
182-31-080.
A school employee who waives enrollment in SEBB medical to enroll in PEBB
medical also waives enrollment in SEBB dental and SEBB vision.
(b) An employee in the PEBB program who
waives PEBB medical and PEBB dental for SEBB medical must be enrolled in SEBB
dental and SEBB vision. If the employee is not already enrolled in SEBB dental
and SEBB vision, the SEBB program will automatically enroll the employee in the
associated subscriber's SEBB dental and SEBB vision.
(c) If the school employee is enrolled only
in SEBB dental and SEBB vision, and is also enrolled in PEBB medical, and no
action is taken to resolve their dual enrollment, the school employee will
remain in PEBB medical. The SEBB program will automatically disenroll the
school employee from SEBB dental and SEBB vision in which they are enrolled. If
the school employee is not already enrolled in PEBB dental, the PEBB program
will automatically enroll them in PEBB dental as described in WAC
182-12-123(6)(h).
The school employee's enrollment in SEBB program life insurance, accidental
death and dismemberment (AD&D) insurance, and long-term disability (LTD)
insurance will remain.
(d) If the
school employee is enrolled in SEBB medical and is also an employee in the PEBB
program enrolled in PEBB medical, and the school employee has been enrolled in
PEBB medical longer than they have been enrolled in SEBB medical, and no action
is taken by the school employee to resolve their dual enrollment, they will
remain in PEBB medical. The SEBB program will automatically disenroll the
school employee from SEBB medical, SEBB dental, and SEBB vision. The school
employee's enrollment in SEBB program life insurance, AD&D insurance, and
LTD insurance will remain. If the school employee is not enrolled in medical
under either the PEBB or SEBB program but is enrolled only in PEBB dental, SEBB
dental, and SEBB vision, the school employee will remain in SEBB dental and
SEBB vision. The PEBB program will automatically disenroll the school employee
from PEBB dental.
(e) If the school
employee's dependent is enrolled in any SEBB medical, SEBB dental, or SEBB
vision plan, and the dependent is also an employee in the PEBB program and
enrolled in PEBB medical, and no action is taken by either the school employee
or the dependent to resolve the dependent's dual enrollment, the school
employee's dependent will remain in PEBB medical. The SEBB program will
automatically dis-enroll the school employee's dependent from SEBB medical,
SEBB dental, and SEBB vision in which they are enrolled.
(f) If the school employee's dependent is
enrolled in both SEBB medical and PEBB medical as a dependent and has been
enrolled in PEBB medical longer than they have been enrolled in SEBB medical,
and no action is taken to resolve the dual enrollment, the school employee's
dependent will remain in PEBB medical. The SEBB program will automatically
disenroll the school employee's dependent from SEBB medical, SEBB dental, and
SEBB vision if they are enrolled. If the school employee's dependent who is
eligible as a dependent in both the SEBB and PEBB programs is not enrolled in
any medical but is enrolled only in PEBB dental and SEBB vision (with or
without SEBB dental) as a dependent, the dependent will remain in SEBB vision
and if enrolled, SEBB dental. The PEBB program will automatically disenroll the
dependent from PEBB dental.
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Exception:
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If there is a National Medical Support Notice (NMSN)
or a court order in place, enrollment will be in accordance with the NMSN or
order.
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(g)
If the school employee's dependent, who is also an employee in the PEBB program
who the PEBB program automatically disenrolled from PEBB dental, the SEBB
program will automatically enroll the school employee's dependent in SEBB
vision. The SEBB program will also automatically enroll the school employee's
dependent in SEBB dental, if they are not already enrolled.
(h) If the school employee who is eligible
for the employer contribution toward SEBB benefits was enrolled as a dependent
in PEBB medical and PEBB dental and is removed by the PEBB subscriber, the
school employee will be required to return from waived enrollment as described
in WAC
182-31-080(3)(b).
(i) If the SEBB program automatically
disenrolls an individual from SEBB medical, SEBB dental, or SEBB vision to
resolve their dual enrollment as described in (d), (e), or (f) of this
subsection, but later determines that the school employee did take action to
resolve their dual enrollment within the required timelines, the SEBB program
will reinstate coverage retroactive to the first of the month in which the
individual was disenrolled.
