Current through Register Vol. 24-18, September 15, 2024
To be enrolled in SEBB health plan coverage, a dependent must
be eligible under this section and the subscriber must comply with enrollment
procedures outlined in WAC
182-31-150.
The school employees benefits board (SEBB) program verifies
the eligibility of all dependents and will request documents from subscribers
that provide evidence of a dependent's eligibility. The SEBB program reserves
the right to review a dependent's eligibility at any time. The SEBB program
will remove a subscriber's enrolled dependents from health plan coverage if the
SEBB program is unable to verify a dependent's eligibility. A dependent will
not be enrolled in SEBB health plan coverage if the SEBB program or the SEBB
organization is unable to verify the dependent's eligibility within the SEBB
program enrollment timelines.
The subscriber must provide notice, in writing, when their
dependent is not eligible under this section as described in WAC
182-31-150(2)(a).
(1) Legal spouse. A former spouse is not an
eligible dependent upon finalization of a divorce or annulment, even if a court
order requires the subscriber to provide health insurance for the former
spouse;
(2) State registered
domestic partner. A former state registered domestic partner is not an eligible
dependent upon dissolution or termination of a partnership, even if a court
order requires the subscriber to provide health insurance for the former
partner;
(3) Children. Children are
eligible through the last day of the month in which their twenty-sixth birthday
occurred except as described in (f) of this subsection. Children are defined as
the subscriber's:
(a) Children based on
establishment of a parent-child relationship as described in
RCW
26.26A.100, except when parental rights have
been terminated;
(b) Children of
the subscriber's spouse, based on the spouse's establishment of a parent-child
relationship, except when parental rights have been terminated. The stepchild's
relationship to the subscriber (and eligibility as a dependent) ends on the
same date the marriage with the spouse ends through divorce, annulment,
dissolution, termination, or death;
(c) Children of the subscriber's state
registered domestic partner, based on the state registered domestic partner's
establishment of a parent-child relationship, except when parental rights have
been terminated. The child's relationship to the subscriber (and eligibility as
a dependent) ends on the same date the subscriber's legal relationship with the
state registered domestic partner ends through divorce, annulment, dissolution,
termination, or death;
(d) Children
for whom the subscriber has assumed a legal obligation for total or partial
support in anticipation of adoption of the child;
(e) Children specified in a court order or
divorce decree for whom the subscriber has a legal obligation to provide
support or health care coverage;
(f) Children of any age with a developmental
or physical disability that renders the child incapable of self-sustaining
employment and chiefly dependent upon the subscriber for support and
maintenance provided such condition occurs before the age of twenty-six:
(i) The subscriber must provide proof of the
disability and dependency within sixty days of the child's attainment of age
twenty-six;
(ii) The subscriber
must notify the SEBB program, in writing, when the child is no longer eligible
under this subsection as described in WAC
182-31-150(2)(a);
(iii) A child with a developmental or
physical disability who becomes self-supporting is not eligible under this
subsection as of the last day of the month in which they become capable of
self-support;
(iv) A child with a
developmental or physical disability age twenty-six and older who becomes
capable of self-support does not regain eligibility if they later become
incapable of self-support; and
(v)
The SEBB program with input from the applicable contracted vendor will
periodically verify the eligibility of a dependent child with a disability
beginning at age twenty-six, but no more frequently than annually after the
two-year period following the child's twenty-sixth birthday. Verification will
require renewed proof of disability and dependence from the
subscriber.
(g) Extended
dependent in the legal custody or legal guardianship of the subscriber, the
subscriber's spouse, or the subscriber's state registered domestic partner. The
legal responsibility is demonstrated by a valid court order and the child's
official residence with the custodian or guardian. Extended dependent child
does not include a foster child unless the subscriber, the subscriber's spouse,
or the subscriber's state registered domestic partner has assumed a legal
obligation for total or partial support in anticipation of adoption.
