Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-31 - Eligible school employees › Section 182-31-140 - Who are eligible dependents?

Current through Register Vol. 24-14, July 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).
The following are eligible as dependents:
(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.