Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-30 - Procedures › Section 182-30-040 - Premium payments and premium refunds

Current through Register Vol. 24-14, July 15, 2024
School employees benefits board (SEBB) insurance coverage
				  premiums and applicable premium surcharges for all subscribers are due as
				  described in this section, except when a SEBB organization is correcting its
				  enrollment error as described in WAC
				  182-30-060(4)
				  or (5).
(1)
Premium payments.
SEBB
				insurance coverage premiums and applicable premium surcharges for all
				subscribers become due the first of the month in which SEBB insurance coverage
				is effective.
Premiums and applicable premium surcharges are due from the
				  subscriber for the entire month of SEBB insurance coverage and will not be
				  prorated during any month.
(a) For
				subscribers not eligible for the employer contribution that are electing to
				enroll in continuation coverage as described in WAC
				182-31-090,
				182-31-100,
				182-31-120,
				or
				182-31-130,
				the first premium payment and applicable premium surcharges are due to the
				health care authority (HCA) or the contracted vendor no later than 45 days
				after the election period ends as described within the Washington
				Administrative Code applicable to the subscriber. 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 vision
				insurance coverage. Premiums associated with life insurance coverage and
				accidental death and dismemberment (AD&D) coverage must be made to the
				contracted vendor. Following the first premium payment, premiums and applicable
				premium surcharges must be paid as premiums become due.
(b) For school employees who are eligible for
				the employer contribution, premiums and applicable premium surcharges are due
				to the SEBB organization or contracted vendor. If a school employee elects
				supplemental coverage or employee-paid long-term disability (LTD) insurance, or
				is enrolled in employee-paid LTD insurance, as described in WAC
				182-30-080(1)(a)
				or (3)(a) or is enrolled in employee-paid LTD
				insurance as described in WAC
				182-30-080(1)(b)
				the school employee is responsible for payment of premiums from the month the
				supplemental coverage or employee-paid LTD insurance begins.
Exception:
A school employee who is on a leave of absence and
							 maintains eligibility for the employer contribution, will have their premiums
							 waived for their employee-paid LTD insurance for the first 90 days. For this
							 purpose, "leave of absence" is defined as a paid or unpaid temporary or
							 indefinite administrative leave, involuntary leave, sick leave, or insurance
							 continued under the federal Family and Medical Leave Act, or paid family and
							 medical leave program as described in WAC
							 182-31-110.
(c)
				Unpaid or underpaid premiums or applicable premium surcharges for all
				subscribers must be paid, and are due from the SEBB organization, subscriber,
				or a subscriber's legal representative to the HCA or the contracted vendor. For
				subscribers not eligible for the employer contribution, monthly premiums or
				applicable premium surcharges that remain unpaid for 30 days will be considered
				delinquent. A subscriber is allowed a grace period of 30 days from the date the
				monthly premiums or applicable premium surcharges become delinquent to pay the
				unpaid premium balance or applicable premium surcharges. If a subscriber, who
				is not eligible for the employer contribution, has monthly premiums or
				applicable premium surcharges remain unpaid for 60 days from the original due
				date, the subscriber's SEBB insurance coverage will be terminated retroactive
				to the last day of the month for which the monthly premiums and any applicable
				premium surcharges were paid. If it is determined by the HCA that payment of
				the unpaid balance in a lump sum would be considered a hardship, the HCA may
				develop a reasonable payment plan up to 12 months in duration with the
				subscriber or the subscriber's legal representative upon request.
(d) Monthly premiums or applicable premium
				surcharges due from a subscriber who is not eligible for the employer
				contribution will be considered unpaid if one of the following occurs:
(i) No payment of premiums or applicable
				premium surcharges are received by the HCA or the contracted vendor and the
				monthly premiums or applicable premium surcharges remain unpaid for 30 days;
				or
(ii) Premium payments or
				applicable premium surcharges received by the HCA or the contracted vendor are
				underpaid by an amount greater than an insignificant shortfall and the monthly
				premiums or applicable premium surcharges remain underpaid for 30 days past the
				date the monthly premiums or applicable premium surcharges were due.