Washington Administrative Code › Title 182 - Health Care Authority › SCHOOL EMPLOYEES BENEFITS BOARD (SEBB) PROGRAM › Chapter 182-30 - Procedures › Section 182-30-020 - Definitions

Current through Register Vol. 24-14, July 15, 2024
The following definitions apply throughout this chapter
				  unless the context clearly indicates another meaning:
"Accidental death and dismemberment insurance" or "AD&D"
				  means basic accidental death and dismemberment (AD&D) insurance paid for by
				  the SEBB organization, as well as supplemental accidental death and
				  dismemberment insurance offered to and paid for by school employees for
				  themselves and their dependents.
"Annual open enrollment" means an annual event set aside for
				  a period of time by the HCA when subscribers may make changes to their health
				  plan enrollment and salary reduction elections for the following plan year.
				  During the annual open enrollment, subscribers may transfer from one health
				  plan to another, enroll or remove dependents from coverage, enroll in coverage,
				  or waive enrollment (see definition of "waive" in this section). School
				  employees eligible to participate in the salary reduction plan may enroll in or
				  change their election under the dependent care assistance program (DCAP), the
				  medical flexible spending arrangement (FSA), or limited purpose FSA. They may
				  also enroll in or opt out of the premium payment plan.
"Authority" or "HCA" means the Washington state health care
				  authority.
"Benefits administrator" means any person or persons
				  designated by the SEBB organization that trains, communicates, and interacts
				  with school employees as the subject matter expert for eligibility, enrollment,
				  and appeals for SEBB benefits.
"Board" means the school employees benefits board established
				  under provisions of
				  RCW
				  41.05.740.
"Calendar days" or "days" means all days including Saturdays,
				  Sundays, and all state legal holidays as set forth in
				  RCW
				  1.16.050.
"Consolidated Omnibus Budget Reconciliation Act" or "COBRA"
				  means continuation coverage as administered under
				  42
				  U.S.C. Secs. 300bb-1 through
				  300bb-8.
"Continuation coverage" means the temporary continuation of
				  SEBB benefits available to enrollees under the Consolidated Omnibus Budget
				  Reconciliation Act (COBRA),
				  42
				  U.S.C. Secs. 300bb-1 through
				  300bb-8, the
				  Uniformed Services Employment and Reemployment Rights Act (USERRA),
				  38 U.S.C. Secs.
				  4301 through
				  4335,
				  or SEBB policies.
"Contracted vendor" means any person, persons, or entity
				  under contract or agreement with the HCA to provide goods or services for the
				  provision or administration of SEBB benefits. The term "contracted vendor"
				  includes subcontractors of the HCA and subcontractors of any person, persons,
				  or entity under contract or agreement with the HCA that provide goods or
				  services for the provision or administration of SEBB benefits.
"Dependent" means a person who meets eligibility requirements
				  in WAC
				  182-31-140.
"Dependent care assistance program" or "DCAP" means a benefit
				  plan whereby school employees may pay for certain employment related dependent
				  care with pretax dollars as provided in the salary reduction plan under chapter
				  41.05 RCW pursuant to
				  26 U.S.C. Sec.
				  129 or other sections of the Internal Revenue
				  Code.
"Director" means the director of the authority.
"Employer-based group health plan" means group medical, group
				  vision, and group dental related to a current employment relationship. It does
				  not include medical, vision, or dental coverage available to retired employees,
				  individual market medical or dental coverage, or government-sponsored programs
				  such as medicare or medicaid.
"Employer-based group medical" means group medical related to
				  a current employment relationship. It does not include medical coverage
				  available to retired employees, individual market medical coverage, or
				  government-sponsored programs such as medicare or medicaid.
"Employer contribution" means the funding amount paid to the
				  HCA by a school employees benefits board (SEBB) organization for its eligible
				  school employees as described under WAC
				  182-31-040
				  or
				  182-30-130.
"Enrollee" means a person who meets all eligibility
				  requirements defined in chapter 182-31 WAC or WAC
				  182-30-130,
				  who is enrolled in SEBB benefits, and for whom applicable premium payments have
				  been made.
"Forms" or "form" means both paper forms and forms completed
				  electronically.
"Health plan" means a plan offering medical, vision, dental,
				  or any combination of these coverages, developed by the board and provided by a
				  contracted vendor or self-insured plans administered by the HCA.
"Insignificant shortfall" means a premium balance owed that
				  is less than or equal to the lesser of $50 or 10 percent of the premium
				  required by the health plan as described in Treasury Regulation
				  26 C.F.R.
				  54.4980B-8.
"Life insurance" means basic life insurance paid for by the
				  SEBB organization, as well as supplemental life insurance or supplemental
				  dependent life insurance offered to and paid for by school employees for
				  themselves and their dependents.
"Limited purpose flexible spending arrangement" or "limited
				  purpose FSA" means a benefit plan whereby eligible school employees may reduce
				  their salary before taxes to pay for dental and vision expenses not reimbursed
				  by insurance as provided in the salary reduction plan established under chapter
				  41.05 RCW pursuant to
				  26 U.S.C. Sec.
				  125 or other sections of the Internal Revenue
				  Code.
"Long-term disability insurance" or "LTD insurance" means
				  employer-paid long-term disability insurance and any employee-paid long-term
				  disability insurance offered by the SEBB program.
"Medical flexible spending arrangement" or "medical FSA"
				  means a benefit plan whereby eligible school employees may reduce their salary
				  before taxes to pay for medical expenses not reimbursed by insurance as
				  provided in the salary reduction plan established under chapter 41.05 RCW
				  pursuant to
				  26 U.S.C. Sec.
				  125 or other sections of the Internal Revenue
				  Code.
"PEBB" means the public employees benefits board.
"Premium payment plan" means a benefit plan whereby school
				  employees may pay their share of group health plan premiums with pretax dollars
				  as provided in the salary reduction plan under chapter 41.05 RCW pursuant to
				  26 U.S.C. Sec.
				  125 or other sections of the Internal Revenue
				  Code.
"Premium surcharge" means a payment required from a
				  subscriber, in addition to the subscriber's medical premium contribution, due
				  to an enrollee's tobacco use or an enrolled subscriber's spouse or state
				  registered domestic partner choosing not to enroll in their employer-based
				  group medical when:
* The spouse's or state registered domestic partner's share
				  of the medical premium is less than 95 percent of the additional cost an
				  employee would be required to pay to enroll a spouse or state registered
				  domestic partner in the public employees benefits board (PEBB) Uniform Medical
				  Plan (UMP) Classic; and
* The benefits have an actuarial value of at least 95 percent
				  of the actuarial value of PEBB UMP Classic benefits.
"Salary reduction plan" means a benefit plan whereby school
				  employees may agree to a reduction of salary on a pretax basis to participate
				  in the dependent care assistance program, medical flexible spending
				  arrangement, limited purpose flexible spending arrangement, or premium payment
				  plan offered pursuant to
				  26 U.S.C. Sec.
				  125 or other sections of the Internal Revenue
				  Code.
"School employee" means:
* All employees of school districts and charter schools
				  established under chapter 28A.710 RCW;
* Represented employees of educational service districts;
				  and
* Effective January 1, 2024, all employees of educational
				  service districts.
"School employees benefits board organization" or "SEBB
				  organization" means a public school district or educational service district or
				  charter school established under chapter 28A.710 RCW that is required to
				  participate in benefit plans provided by the school employees benefits
				  board.
"School year" means school year as defined in
				  RCW
				  28A.150.203(11).
"SEBB" means the school employees benefits board.
"SEBB benefits" means one or more insurance coverages or
				  other school employee benefits administered by the SEBB program within the
				  HCA.
"SEBB insurance coverage" means any health plan, life
				  insurance, accidental death and dismemberment insurance, or long-term
				  disability insurance administered as a SEBB benefit.
"SEBB program" means the program within the HCA that
				  administers insurance and other benefits for eligible school employees (as
				  described in WAC
				  182-31-040
				  or
				  182-30-130)
				  and eligible dependents (as described in WAC
				  182-31-140)
				  .
"Special open enrollment" means a period of time when
				  subscribers may make changes to their health plan enrollment and salary
				  reduction elections outside of the annual open enrollment period when specific
				  life events occur. During the special open enrollment subscribers may change
				  health plans and enroll or remove dependents from coverage. Additionally,
				  school employees may enroll in or waive enrollment (see definition of "waive"
				  in this section). School employees eligible to participate in the salary
				  reduction plan may enroll in or revoke their election under the DCAP, medical
				  FSA, limited purpose FSA, or the premium payment plan and make a new election.
				  For special open enrollment events related to specific SEBB benefits, see WAC
				  182-30-090,
				  182-30-100,
				  182-31-080,
				  and
				  182-31-150.
"State registered domestic partner" has the same meaning as
				  defined in
				  RCW
				  26.60.020(1) and
				  substantially equivalent legal unions from other jurisdictions as defined in
				  RCW
				  26.60.090.
"Subscriber" means the school employee or continuation
				  coverage enrollee who has been determined eligible by the SEBB program or SEBB
				  organization, is enrolled in SEBB benefits, and is the individual to whom the
				  SEBB program and contracted vendors will issue all notices, information,
				  requests, and premium bills on behalf of an enrollee.
"Supplemental coverage" means any life insurance or
				  accidental death and dismemberment (AD&D) insurance coverage purchased by
				  the school employee in addition to the coverage provided by the school
				  employees benefits board (SEBB) organization.
"Tobacco products" means any product made with or derived
				  from tobacco that is intended for human consumption, including any component,
				  part, or accessory of a tobacco product. This includes, but is not limited to,
				  cigars, cigarettes, pipe tobacco, chewing tobacco, snuff, and other tobacco
				  products. It does not include e-cigarettes or United States Food and Drug
				  Administration (FDA) approved quit aids.
"Tobacco use" means any use of tobacco products within the
				  past two months. Tobacco use, however, does not include the religious or
				  ceremonial use of tobacco.
"Waive" means an eligible school employee affirmatively
				  declining enrollment in SEBB medical because the school employee is enrolled in
				  other employer-based group medical, a TRICARE plan, or medicare as allowed
				  under WAC
				  182-31-080.
				  A school employee may waive enrollment in SEBB medical to enroll in PEBB
				  medical only if they are enrolled in PEBB dental. A school employee who waives
				  enrollment in SEBB medical to enroll in PEBB medical also waives enrollment in
				  SEBB dental and SEBB vision.
"Week" means a seven-day period starting on Sunday and ending
				  on Saturday.