reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-26 › Part 4 › Section 182-26-400

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						70.47A.060. 08-22-041 (Order 08-02), §
												182-26-400, filed 10/31/08,
						effective 12/1/08.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-26 › Part 4 › Section 182-26-405

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						70.47A.060. 08-22-041 (Order 08-02), §
												182-26-405, filed 10/31/08,
						effective 12/1/08.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-26 › Part 4 › Section 182-26-410

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						70.47A.060. 08-22-041 (Order 08-02), §
												182-26-410, filed 10/31/08,
						effective 12/1/08.
Washington Administrative Code › Title 182 - Health Care Authority › PUBLIC EMPLOYEES BENEFITS BOARD (PEBB) PROGRAM › Chapter 182-26 › Part 5 › Section 182-26-500

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						70.47A.060. 08-22-041 (Order 08-02), §
												182-26-500, filed 10/31/08,
						effective 12/1/08.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-30 - Procedures › Section 182-30-010 - Purpose

Current through Register Vol. 24-14, July 15, 2024
The purpose of this chapter is to establish school employees
				  benefits board (SEBB) program enrollment criteria and procedures for school
				  employees eligible for SEBB benefits under
				  RCW
				  41.05.740(6).
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-30 - Procedures › Section 182-30-030 - Employer contribution for school employees benefits board (SEBB) benefits

Current through Register Vol. 24-14, July 15, 2024
The employer contribution must be used to provide school
				  employees benefits board (SEBB) insurance coverage for the basic life insurance
				  benefit, basic accidental death and dismemberment (AD&D) insurance benefit,
				  employer-paid longterm disability (LTD) insurance benefit, medical insurance,
				  vision insurance, dental insurance, SEBB program administrative costs, the
				  school employee remittance required in
				  RCW
				  28A.400.410 and to establish a reserve for
				  any remaining balance. There is no employer contribution available for any
				  other insurance coverage for school employees employed by SEBB
				  organizations.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-30 - Procedures › Section 182-30-060 - How do school employees benefits board (SEBB) organizations and contracted vendors correct enrollment errors?

Current through Register Vol. 24-14, July 15, 2024
(1) A school
				employees benefits board (SEBB) organization or contracted vendor that makes
				one or more of the following enrollment errors must correct the error as
				described in subsections (2) through (5) of this section.
(a) Failure to timely notify a school
				employee of their eligibility for SEBB benefits and the employer contribution
				as described in WAC
				182-31-030;
(b) Failure to enroll a school employee or
				their dependents in SEBB benefits as elected by the school employee, if the
				election was timely;
(c) Failure to
				enroll a school employee and their dependents in SEBB benefits as described in
				WAC 182-30-080(1)(b);
(d) Failure to accurately reflect a school
				employee's premium surcharge attestation on the school employee's
				account;
(e) Enrolling a school
				employee or their dependents in SEBB insurance coverage when they are not
				eligible as described in WAC
				182-31-040 or
				182-31-140 and it is clear there
				was no fraud or intentional misrepresentation by the school employee involved;
				or
(f) Providing incorrect
				information, via a benefits administrator or contracted vendor, regarding SEBB
				benefits to the school employee that they relied upon.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-30 - Procedures › Section 182-30-070 - The employer contribution is set by the health care authority (HCA) and paid to the HCA for all eligible school employees

Current through Register Vol. 24-14, July 15, 2024
School employees benefits board (SEBB) organizations must pay
				  the employer contributions to the health care authority (HCA) for SEBB
				  insurance coverage for all eligible school employees and their enrolled
				  dependents.
(1) Employer contributions
				are set by the HCA, and are subject to the approval of the governor for
				availability of funds as specifically appropriated by the legislature for that
				purpose. The employer contribution for school employees eligible under
				RCW
				41.05.740(6)(e) are set by
				the HCA.
(2) Employer contributions
				must include an amount determined by the HCA to pay administrative costs to
				administer SEBB benefits for school employees.
(3) Each school employee of a SEBB
				organization on leave under the federal Family and Medical Leave Act (FMLA) or
				the paid family medical leave program is eligible for the employer contribution
				as described in WAC 182-31110.
(4)
				The entire employer contribution is due and payable to HCA even if enrollment
				is waived as described in WAC
				182-31-080,
				except for school employees eligible under WAC
				182-30-130.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-30 - Procedures › Section 182-30-075 - Subscriber address requirements

Current through Register Vol. 24-14, July 15, 2024
(1)
				All school employees must provide their school employees benefits board (SEBB)
				organization with their correct address and update their address if it changes.
				A subscriber on continuation coverage must provide the SEBB program with their
				correct address and updates to their address if it changes.
(2) In the event of an appeal, the appellant
				must update their address as required in WAC
				182-32-055.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-30 - Procedures › Section 182-30-085 - What happens if my health plan becomes unavailable?

Current through Register Vol. 24-14, July 15, 2024
(1) A subscriber
				must select a new health plan when their previously selected health plan
				becomes unavailable due to a change in contracting service area as described
				below:
(a) When a health plan becomes
				unavailable during the plan year, a subscriber must elect a new health plan no
				later than 60 days after the date their previously selected health plan becomes
				unavailable.
(i) A school employee must submit
				the required form to their school employees benefits board (SEBB) organization
				electing their new health plan.
(ii) All other subscribers must submit the
				required forms to the SEBB program electing their new health plan.
(iii) The effective date of the change in
				health plan will be the first day of the month following the later of the date
				the health plan becomes unavailable or the date the form is received. If that
				day is the first of the month, the change in health plans begins on that
				day.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-30 - Procedures › Section 182-30-100 - When may a school employee enroll, or revoke an election and make a new election under the premium payment plan, medical flexible spending arrangement (FSA), limited purpose FSA, or dependent care assistance program (DCAP)?

Current through Register Vol. 24-14, July 15, 2024
A school employee who is eligible to participate in the
				  salary reduction plan as described in WAC
				  182-31-060 may enroll, or revoke
				  their election and make a new election under the premium payment plan, medical
				  flexible spending arrangement (FSA), limited purpose FSA, or dependent care
				  assistance program (DCAP) at the following times:
(1) When newly eligible under WAC
				182-31-040 and enrolling as
				described in WAC
				182-30-080(1).
(2)
During annual open
				enrollment:
An eligible school employee may elect to enroll in or opt
				out of participation under the premium payment plan during the annual open
				enrollment by submitting the required form to their school employees benefits
				board (SEBB) organization. An eligible school employee may elect to enroll or
				reenroll in the medical FSA, limited purpose FSA, DCAP, or both an FSA and DCAP
				during the annual open enrollment by submitting the required forms to their
				SEBB organization or applicable contracted vendor as instructed. All required
				forms must be received no later than the last day of the annual open
				enrollment. The enrollment or new election becomes effective January 1st of the
				following year.
(a) School employees cannot
				enroll in a medical FSA and a limited purpose FSA in the same year.
(b) School employees enrolled in a high
				deductible health plan (HDHP) with a health savings account (HSA) cannot also
				enroll in a medical FSA in the same plan year. School employees who elect
				enrollment in the HDHP with a HSA and a medical FSA will only be enrolled in a
				HDHP with a HSA.
(c) If a school
				employee enrolls in a HDHP with a HSA during annual open enrollment and has a
				carryover amount from a medical FSA, the school employee will be enrolled in a
				limited purpose FSA and the carryover amount will be deposited into the limited
				FSA.
(d) School employees who are
				not enrolled in a HDHP with a HSA and elect both a medical FSA and a limited
				purpose FSA will be enrolled in the medical FSA.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-30 - Procedures › Section 182-30-110 - Which school employees benefits board (SEBB) organization is responsible to pay the employer contribution for eligible school employees changing SEBB organizations?

Current through Register Vol. 24-14, July 15, 2024
When an eligible school employee's employment relationship
				  terminates with a school employees benefits board (SEBB) organization at any
				  time during the month for which a premium contribution is due and that school
				  employee moves to another SEBB organization, the SEBB organization losing the
				  school employee is responsible for the payment of the employer contribution for
				  the school employee for that month. The SEBB organization the school employee
				  is moving to is responsible for payment of the employer contribution for the
				  school employee beginning the first day of the month following the move if the
				  school employee is eligible.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-30 - Procedures › Section 182-30-120 - Advertising or promotion of school employees benefits board (SEBB) benefit plans

Current through Register Vol. 24-14, July 15, 2024
(1) In order to
				assure equal and unbiased representation of school employees benefits board
				(SEBB) benefits, contracted vendors must comply with all of the following:
(a) All materials describing SEBB benefits
				must be prepared by or approved by the heath care authority (HCA) before
				use.
(b) Distribution or mailing of
				all benefit descriptions must be performed by or under the direction of the
				HCA.
(c) All media announcements or
				advertising by a contracted vendor which includes any mention of the "school
				employees benefits board," "SEBB," "health care authority," "HCA," any
				reference to benefits for "school employees," or any group of enrollees covered
				by SEBB benefits, must receive the advance written approval of the
				HCA.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-30 - Procedures › Section 182-30-130 - What are the requirements for a school employees benefits board (SEBB) organization engaging in local negotiations regarding SEBB benefits eligibility criteria?

Current through Register Vol. 24-14, July 15, 2024
This section describes the terms and conditions for a school
				  employees benefits board (SEBB) organization that is engaging in local
				  negotiations regarding eligibility for school employees as described in
				  RCW
				  41.05.740(6)(e).
(1) A SEBB organization must provide a
				current ratified collective bargaining agreement (CBA) and information on all
				eligible school employees under the CBA to the health care authority (HCA) by
				the start of the school year.
(2) A
				SEBB organization must offer all of, and only, the following SEBB benefits to
				employees and their dependents:
(a) Medical
				(includes the wellness incentive);
(b) Dental;
(c) Vision;
(d) Basic life;
(e) Basic accidental death and dismemberment
				(AD&D) insurance.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-30 - Procedures › Section 182-30-140 - What is the process for school districts to offer optional benefits?

Current through Register Vol. 24-14, July 15, 2024
(1) School
				districts may offer optional benefits that do not compete with any form of the
				basic or optional benefits offered in the school employees' benefits board
				(SEBB) program either under the SEBB's authority in
				RCW
				41.05.740 or offered under the health care
				authority's (HCA) authority in the salary reduction plan authorized in
				RCW
				41.05.300 and
				41.05.310.
				Optional benefits must be paid for by the school employee without an employer
				contribution, except for when a school employee participates in voluntary
				employees' beneficiary association accounts (VEBA), which may have an employer
				contribution as described in
				RCW
				28A.400.210(3). Optional
				benefits may include:
(a) Emergency
				transportation;
(b) Identity
				protection;
(c) Legal
				aid;
(d) Long-term care
				insurance;
(e) Noncommercial
				personal automobile insurance;
(f)
				Personal homeowner's or renter's insurance;
(g) Pet insurance;
(h) Specified disease or illness-triggered
				fixed payment insurance, hospital confinement fixed payment insurance, or other
				fixed payment insurance offered as an independent, noncoordinated benefit
				regulated by the office of the insurance commissioner;
(i) Travel insurance; and
(j) VEBA.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-31 - Eligible school employees › Section 182-31-010 - Purpose

Current through Register Vol. 24-14, July 15, 2024
The purpose of this chapter is to establish school employees
				  benefits board (SEBB) eligibility criteria for and the effective date of
				  enrollment in SEBB approved benefits. The rules within this chapter are
				  applicable for school employees eligible for SEBB benefits under
				  RCW
				  41.05.740(6).
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-31 - Eligible school employees › Section 182-31-030 - What are the obligations of a school employees benefits board (SEBB) organization in the application of school employee eligibility?

Current through Register Vol. 24-14, July 15, 2024
(1) All school
				employees benefits board (SEBB) organizations must carry out all actions,
				policies, and guidance issued by the SEBB program which are necessary for the
				operation of benefit plans, education of school employees, claims
				administration, and appeals process including those described in chapters
				182-30, 182-31, and 182-32 WAC. SEBB organizations must:
(a) Use the methods provided by the SEBB
				program to determine eligibility and enrollment in benefits;
(b) Provide eligibility determination reports
				with content and in a format designed and communicated by the SEBB
				program;
(c) Support SEBB program
				auditing of eligibility and enrollment decisions as needed; and
(d) Carry out corrective action and pay any
				penalties imposed by the health care authority (HCA) and established by the
				board when the SEBB organization's eligibility determinations fail to comply
				with the criteria under these rules.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-31 - Eligible school employees › Section 182-31-040 - How do school employees establish eligibility for the employer contribution toward school employees benefits board (SEBB) benefits and when do SEBB benefits begin?

Current through Register Vol. 24-14, July 15, 2024
(1) Eligibility
				shall be determined solely by the criteria that most closely describes the
				school employee's work circumstance.
(2) 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 school employees benefits board (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.
(3) 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.
(4) School employee
				eligibility criteria shall be determined in the following order:
(a) A school employee is eligible for the
				employer contribution toward SEBB benefits if they are anticipated to work at
				least 630 hours per school year. The eligibility effective date 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.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-31 - Eligible school employees › Section 182-31-060 - Who is eligible to participate in the salary reduction plan?

Current through Register Vol. 24-14, July 15, 2024
School employees eligible for the employer contribution
				  toward school employees benefits board (SEBB) benefits are eligible to
				  participate in the premium payment plan under the state's salary reduction
				  plan. School employees eligible for SEBB benefits as described in WAC
				  182-31-040
				  may also elect to participate in the medical FSA, limited purpose FSA, or DCAP
				  programs provided they elect participation within the time frames described in
				  WAC
				  182-30-100.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-31 - Eligible school employees › Section 182-31-070 - Is dual enrollment in school employees benefits board (SEBB) and public employees benefits board (PEBB) prohibited?

Current through Register Vol. 24-14, July 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.
Exception:
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.
(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.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-31 - Eligible school employees › Section 182-31-093 - School employees benefits boards (SEBB) continuation coverage for nonrepresented educational service district (ESD) school employees and their dependents who are not eligible for benefits under the SEBB program as of January 1, 2024, and for dependents who were already on an ESD's or public employees benefits board (PEBB) program's continuation coverage as of December 31, 2023

Current through Register Vol. 24-14, July 15, 2024
Nonrepresented educational service district (ESD) school
				  employees and their dependents may gain temporary eligibility for school
				  employees benefits board (SEBB) benefits, on a self-pay basis, if they meet the
				  following criteria:
(1) A
				nonrepresented ESD school employee and their dependents who are enrolled in
				medical, dental, or vision under a group plan offered by a SEBB organization on
				December 31, 2023, who lose eligibility because the school employee is not
				eligible under WAC
				182-30-130 or
				182-31-040, may elect to continue
				existing enrollment in one or more of the following SEBB benefits: Medical,
				dental, or vision coverage. These benefits will be provided for a maximum of 18
				months.
(2) A dependent of a SEBB
				eligible nonrepresented school employee of an ESD who is enrolled in medical,
				dental, or vision under a school employee's account on December 31, 2023, who
				loses eligibility because they are not an eligible dependent under WAC
				182-31-140 may continue existing
				enrollment for a maximum of 36 months.
(3) A dependent of a nonrepresented school
				employee who is continuing medical, dental, or vision coverage through an ESD
				on December 31, 2023, may elect to continue existing enrollment to finish out
				their remaining months, up to the maximum number of months authorized by
				Consolidated Omnibus Budget Reconciliation Act for a similar event, by
				enrolling in a medical, dental, or vision plan offered through the SEBB
				program.
(4) The nonrepresented
				school employee's or the dependent's election must be received by the SEBB
				program no later than 60 days after January 1, 2024. If the nonrepresented
				school employee's or a dependent's monthly premium or applicable premium
				surcharges remain unpaid for 60 days from the original due date, the
				nonrepresented school employee's SEBB benefits will be terminated retroactive
				to the last day of the month for which the monthly premium and applicable
				premium surcharges were paid as described in WAC
				182-30-040(1)(c).
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-31 - Eligible school employees › Section 182-31-110 - What options are available if a school employee is approved for the federal Family and Medical Leave Act (FMLA) or the paid family and medical leave program?

Current through Register Vol. 24-14, July 15, 2024
(1) A school
				employee on approved leave under the federal Family and Medical Leave Act
				(FMLA) may continue to receive the employer contribution toward school
				employees benefits board (SEBB) benefits in accordance with the federal FMLA.
				The school employee may also continue current supplemental life, supplemental
				accidental death and dismemberment (AD&D), and employee-paid long-term
				disability (LTD) insurance. The school employee's SEBB organization is
				responsible for determining if the school employee is eligible for leave under
				FMLA and the duration of such leave.
(2) A school employee on approved leave under
				the paid family and medical leave program under chapter 50A.05 RCW may continue
				to receive the employer contribution toward SEBB benefits in accordance with
				RCW
				50A.35.020. The school employee may also
				continue current supplemental life, supplemental AD&D, and employee-paid
				LTD insurance. The employment security department is responsible for
				determining if the school employee is eligible for the paid family and medical
				leave program.
(3) If a school
				employee exhausts the period of leave approved under FMLA or paid family and
				medical leave, SEBB benefits may be continued by self-paying the premium and
				applicable premium surcharges set by the health care authority (HCA), with no
				contribution from the SEBB organization, as described in WAC
				182-31-100(1).
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-31 - Eligible school employees › Section 182-31-120 - What options for continuation coverage are available to school employees during their appeal of a grievance?

Current through Register Vol. 24-14, July 15, 2024
(1) A
				school employee awaiting the hearing outcome of a grievance action before any
				of the following may continue their school employees benefits board (SEBB)
				insurance coverage by self-paying the premium and applicable premium surcharges
				set by the health care authority (HCA), with no contribution from the SEBB
				organization, on the same terms as a school employee who is granted leave as
				described in WAC
				182-31-100(1):
(a) An arbitrator;
(b) A grievance or appeals committee
				established under a collective bargaining agreement for union represented
				employees; or
(c) A
				court.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-31 - Eligible school employees › Section 182-31-130 - What options for continuation coverage are available to dependents who cease to meet the eligibility criteria as described in WAC 182-31-140 or 182-30-130?

Current through Register Vol. 24-14, July 15, 2024
If eligible, dependents may continue health plan enrollment
				  under one of the continuation coverage options in subsection (1) or (2) of this
				  section by self-paying the premiums and applicable premium surcharges set by
				  the health care authority (HCA), with no contribution from the school employees
				  benefits board (SEBB) organization, following their loss of eligibility under
				  the subscriber's health plan coverage. The dependent's first premium payment
				  and applicable premium surcharges are due no later than forty-five days after
				  the dependent's election period ends as described in WAC
				  182-31-090
				  or
				  182-12-265,
				  whichever applies. Premiums and applicable premium surcharges associated with
				  continuing SEBB medical, must be made to the HCA as well as premiums associated
				  with continuing SEBB dental or SEBB vision insurance coverage. Following the
				  dependent's first premium payment, the dependent must pay premium and
				  applicable premium surcharges as they become due. If the monthly premium or
				  applicable premium surcharges remain unpaid for sixty days from the original
				  due date, SEBB insurance coverage will be terminated retroactive to the last
				  day of the month for which the monthly premium and applicable premium
				  surcharges were paid as described in WAC
				  182-30-040(1)
				  (c). The SEBB program must receive the
				  required forms as outlined in the SEBB initial notice of COBRA and continuation
				  coverage rights. Options for continuing health plan enrollment are based on the
				  reason that eligibility was lost.
(1)
				Dependents who lose eligibility due to the death of a school employee may be
				eligible to continue health plan enrollment as described in WAC
				182-12-265;
				or
(2) Dependents who lose
				eligibility because they no longer meet the eligibility criteria as described
				in WAC
				182-31-140
				are eligible to continue SEBB medical, dental, or vision under provisions of
				the federal Consolidated Omnibus Budget Reconciliation Act (COBRA). See WAC
				182-31-090
				for more information on COBRA.
(3)
				A subscriber's state registered domestic partner and the state registered
				domestic partner's children may continue SEBB medical, dental, or vision on the
				same terms and conditions as spouses and other eligible dependents under COBRA
				as described under
				RCW
				26.60.015.
(4) No continuation coverage will be offered
				unless the SEBB program is notified through hand delivery or United States
				Postal Service mail of the qualifying event as outlined in the SEBB initial
				notice of COBRA and continuation coverage rights.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-31 - Eligible school employees › Section 182-31-135 - Where may school employee survivors go for additional coverage options?

Current through Register Vol. 24-14, July 15, 2024
A school employee's spouse, state registered domestic
				  partner, or child who loses eligibility for the employer contribution toward
				  school employees benefits board (SEBB) benefits due to the death of an eligible
				  school employee may be eligible to enroll in or defer enrollment as a survivor
				  under public employees benefits board (PEBB) retiree insurance coverage as
				  described in WAC
				  182-12-265
				  rather than enrolling in continuation coverage.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-31 - Eligible school employees › Section 182-31-150 - When may subscribers enroll or remove eligible dependents?

Current through Register Vol. 24-14, July 15, 2024
(1)
Enrolling
				dependents in school employees benefits board (SEBB) health plan coverage,
				supplemental dependent life insurance, and accidental death and dismemberment
				(AD&D) insurance.
A dependent must be enrolled in the same health
				plan coverage as the subscriber, and the subscriber must be enrolled in health
				plan coverage to enroll their dependent in health plan coverage. A dependent
				with more than one source of eligibility for enrollment in the public employees
				benefits board (PEBB) and SEBB programs is limited to a single enrollment in
				medical, dental, and vision plans in either the PEBB or SEBB program.
				Subscribers must satisfy the enrollment requirements as described in subsection
				(4) of this section and may enroll eligible dependents at the following times:
(a)
When the subscriber becomes
				eligible
and enrolls in SEBB benefits. If eligibility is verified the
				dependent's effective date will be as follows:
(i) SEBB health plan coverage will be the
				same as the subscriber's effective date;
(ii) Supplemental dependent life insurance or
				AD&D insurance, if elected, will be effective the first day of the month
				following the date the contracted vendor receives the required form or approves
				the enrollment. A newly born child must be at least 14 days old before
				supplemental dependent life insurance or AD&D insurance coverage is
				effective.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-31 - Eligible school employees › Section 182-31-160 - National Medical Support Notice (NMSN)

Current through Register Vol. 24-14, July 15, 2024
(1) When a National Medical Support Notice
				(NMSN) requires a subscriber to provide health plan coverage for a dependent
				child the following provisions apply:
(a) The
				subscriber may enroll their dependent child and request changes to their health
				plan coverage as described under (c) of this subsection. School employees
				submit the required forms to their school employees benefits board (SEBB)
				organization. Subscribers on continuation coverage submit the required forms to
				the SEBB program;
(b) If the
				subscriber fails to request enrollment or health plan coverage changes as
				directed by the NMSN, the SEBB organization or the SEBB program may make
				enrollment or health plan coverage changes according to (c) of this subsection
				upon request of:
(i) The child's other
				parent; or
(ii) Child support
				enforcement program.
(c)
				Changes to health plan coverage or enrollment are allowed as directed by the
				NMSN:
(i) The dependent will be enrolled
				under the subscriber's health plan coverage as directed by the NMSN;
(ii) A school employee who has waived SEBB
				medical as described in WAC
				182-31-080
				will be enrolled in medical as directed by the NMSN, in order to enroll the
				dependent;
(iii) The subscriber's
				selected health plan will be changed if directed by the NMSN;
(iv) If the dependent is already enrolled
				under another SEBB subscriber, the dependent will be removed from the other
				health plan coverage and enrolled as directed by the NMSN;
(v) If the dependent is enrolled in both
				public employees benefits board medical and SEBB medical as a dependent as
				described in WAC
				182-31-070(6)(f)
				and there is a NMSN in place, enrollment will be in accordance with the NMSN;
				or
(vi) If the subscriber is
				eligible for and elects Consolidated Omnibus Budget Reconciliation Act (COBRA)
				or other continuation coverage, the NMSN will be enforced and the dependent
				must be covered in accordance with the NMSN.
(d) Changes to health plan coverage or
				enrollment as described in (c)(i) through (iii) of this subsection will begin
				the first day of the month following receipt by the SEBB organization of the
				NMSN. If the NMSN is received by the SEBB organization on the first day of the
				month, the change to health plan coverage or enrollment begins on that day. A
				dependent will be removed from the subscriber's health plan coverage as
				described in (c)(iv) of this subsection the last day of the month the NMSN is
				received. If that day is the first of the month, the change in enrollment will
				be made the last day of the previous month.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-31 - Eligible school employees › Section 182-31-190 - School employees benefits board (SEBB) wellness incentive program eligibility and procedural requirements

Current through Register Vol. 24-14, July 15, 2024
The board annually determines the design of the SEBB wellness
				  incentive program.
(1) All subscribers
				are eligible to participate in the SEBB well-ness incentive program.
(2) Effective January 1, 2020, to receive the
				SEBB wellness incentive of a reduction to the subscriber's medical plan
				deductible or a deposit to the subscriber's health savings account for the
				following plan year, eligible subscribers must complete SEBB wellness incentive
				program requirements during the current plan year by the following deadline:
(a) For subscribers continuing enrollment in
				SEBB medical and subscribers enrolling in SEBB medical with an effective date
				in January through September, the deadline is November 30th; or
(b) For subscribers enrolling in SEBB medical
				with an effective date in October through December, the deadline is December
				31st.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-32 - Appeals practices and procedures › Part I - GENERAL PROVISIONS › Section 182-32-010 - Purpose

Current through Register Vol. 24-14, July 15, 2024
This chapter describes the general rules and procedures
					 that apply to the health care authority's brief adjudicative proceedings and
					 formal administrative hearings for the school employees benefits board
					 program.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-32 - Appeals practices and procedures › Part I - GENERAL PROVISIONS › Section 182-32-055 - Mailing address changes

Current through Register Vol. 24-14, July 15, 2024
(1) During
				  the appeal process, if the appellant's mailing address changes, the appellant
				  must notify the school employees benefits board (SEBB) appeals unit as soon as
				  possible.
(2) If the appellant does
				  not notify the SEBB appeals unit of a change in the appellant's mailing address
				  and the SEBB appeals unit continues to serve notices and other important
				  documents to the appellant's last known mailing address, the documents will be
				  deemed served on the appellant.
(3)
				  This requirement to provide notice of an address change is in addition to WAC
				  182-30-075 that require a subscriber to update their address with the SEBB
				  appeals unit.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-32 - Appeals practices and procedures › Part I - GENERAL PROVISIONS › Section 182-32-058 - Service or serve

Current through Register Vol. 24-14, July 15, 2024
(1) When the rules
				  in this chapter or in other school employees benefits board (SEBB) program
				  rules or statutes require a party to serve copies of documents on other
				  parties, a party must send copies of the documents to all other parties or
				  their representatives as described in this chapter. In this section,
				  requirements for service or delivery by a party apply also when service is
				  required by the presiding officer or reviewing officer or officers, or hearing
				  officer.
(2) Unless otherwise
				  stated in applicable law, documents may be sent only as identified in this
				  chapter to accomplish service. A party may serve someone by:
(a) Personal service (hand
				  delivery);
(b) First class,
				  registered, or certified mail sent via the United States Postal Service or
				  Washington state consolidated mail services;
(c) Fax;
(d) Commercial delivery service; or
(e) Legal messenger service.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-32 - Appeals practices and procedures › Part I - GENERAL PROVISIONS › Section 182-32-064 - Applicable rules and laws

Current through Register Vol. 24-14, July 15, 2024
(1) A school
				  employees benefits board (SEBB) organization must apply SEBB program rules
				  adopted in the Washington Administrative Code (WAC) and follow instructions
				  from the authority.
(2) A presiding
				  officer, reviewing officer or officers, or hearing officer must first apply the
				  applicable SEBB program rules adopted in the WAC. If no SEBB program rule
				  applies, the presiding officer, reviewing officer or officers, or hearing
				  officer must decide the issue according to the best legal authority and
				  reasoning available, including federal and Washington state constitutions,
				  statutes, regulations, significant decisions indexed as described in WAC
				  182-32-130,
				  and court decisions.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-32 - Appeals practices and procedures › Part I - GENERAL PROVISIONS › Section 182-32-066 - Burden of proof, standard of proof, and presumptions

Current through Register Vol. 24-14, July 15, 2024
(1) The burden of
				  proof is a party's responsibility to provide evidence regarding disputed facts
				  and persuade the presiding officer, reviewing officer or officers, or hearing
				  officer that a position is correct based on the standard of proof. Unless
				  stated otherwise in rules or law, the appellant has the burden of proof in a
				  brief adjudicative proceeding or formal administrative hearing.
(2) Standard of proof refers to the amount of
				  evidence needed to prove a party's position. Unless stated otherwise in rules
				  or law, the standard of proof in a brief adjudicative proceeding or formal
				  administrative hearing is a preponderance of the evidence, meaning that
				  something is more likely to be true than not.
(3) Public officers and school employees
				  benefits board (SEBB) organizations are presumed to have properly performed
				  their duties and acted as described in the law, unless preponderance of the
				  evidence to the contrary is presented. A party challenging this presumption
				  bears the burden of proof.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-32 - Appeals practices and procedures › Part I - GENERAL PROVISIONS › Section 182-32-120 - Computation of time

Current through Register Vol. 24-14, July 15, 2024
(1) In computing
				  any period of time prescribed by this chapter, the day of the event from which
				  the time begins to run is not included. (For example, if an initial order is
				  served on Friday and the party has twenty-one days to request a review, start
				  counting the days with Saturday.)
(2) As provided in subsection (3) of this
				  section, the last day of the period so computed is included unless it is a
				  Saturday, Sunday, or legal holiday as defined in
				  RCW
				  1.16.050, in which case the period extends to
				  the next business day.
(3) When the
				  period of time prescribed or allowed is ten days or less, intermediate
				  Saturdays, Sundays and state legal holidays must be excluded in the
				  computation.
(4) The deadline is
				  5:00 p.m. on the last day of the computed period.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-32 - Appeals practices and procedures › Part I - GENERAL PROVISIONS › Section 182-32-130 - Index of significant decisions

Current through Register Vol. 24-14, July 15, 2024
(1)
				  A final order may be relied upon, used, or cited as precedent by a party only
				  if the final order has been indexed in the authority's index of significant
				  decisions in accordance with
				  RCW
				  34.05.473(1)(b).
(2) An index of significant decisions is
				  available to the public on the health care authority's (HCA) website. As
				  decisions are indexed they will be available on the website.
(3) A final order published in the index of
				  significant decisions may be removed from the index when:
(a) A published decision entered by the court
				  of appeals or the supreme court reverses an indexed final order; or
(b) HCA determines that the indexed final
				  order is no longer precedential due to changes in statute, rule, or
				  policy.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-32 - Appeals practices and procedures › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-32-2000 - Brief adjudicative proceedings

Current through Register Vol. 24-14, July 15, 2024
Pursuant to
					 RCW
					 34.05.482, the authority may use brief
					 adjudicative proceedings for issues identified in this chapter when doing so
					 would not violate law, or when protection of the public interest does not
					 require the authority to give notice and an opportunity to participate to
					 persons other than the parties, or the issue and interests involved in the
					 controversy do not warrant use of the procedures of
					 RCW
					 34.05.413 through
					 34.05.476 which
					 govern formal administrative hearings.
Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-32 - Appeals practices and procedures › Part II - BRIEF ADJUDICATIVE PROCEEDINGS › Section 182-32-2005 - Record-Brief adjudicative proceeding

Current through Register Vol. 24-14, July 15, 2024
The record in a brief adjudicative proceeding consists of
					 any documents regarding the matter, considered or prepared by the presiding
					 officer for the brief adjudicative proceeding or by the reviewing officer or
					 officers for any review. The authority's record does not have to constitute the
					 exclusive basis for agency action, unless otherwise required by
					 law.