2020 SEBB School Employee Enrollment Guide

Selecting a medical plan .25Selecting a vision plan.56How can I compare the medical plans? 25Medical plan differences to consider 25What type of plan should I select? 26UMP High Deductible with a health savingsaccount (HSA) 27Who is eligible for UMP High Deductiblewith an HSA? 28Are there special considerations if I enroll in UMPHigh Deductible mid-year? 28Other features of UMP High Deductiblewith an HSA 28How do I designate or update beneficiaries for myHSA? 28What happens to my health savings accountwhen I leave UMP High Deductible? 28How do I find Summaries of Benefitsand Coverage (SBC)? 29Vision plan options 56Behavioral health coverage.30Ensuring timely access to care. 30Compare coverage by plan. 30Crisis information. 30Behavioral Health Benefits Comparison.31Medical Plan Premiums and DeductiblesAvailable by County.33Medical Plans Available by School District.39Medical Benefits Comparison . .44Selecting a dental plan.54Things to keep in mind before you selecta dental plan or provider 54How do the DeltaCare and Willamette DentalGroup plans work? 54Dental plan options 54How does the Uniform Dental Plan(UDP) work? 55Dental Benefits Comparison.558Vision Benefits Comparison.57Life and AD&D insurance.60What are (employer-paid) basic lifeinsurance and basic AD&D insurance? 60What are (employee-paid) supplementallife and AD&D insurance? 60How do I designate beneficiaries for mylife and AD&D insurance? 61What do supplemental life andAD&D insurance cost? 61When can I enroll in supplementallife insurance? 61When can I enroll in supplementalAD&D insurance? 61How do I enroll in supplemental life andsupplemental AD&D insurance? 62How do I create an online accountwith MetLife? 62If I leave employment, can I continuelife insurance coverage? 62Long-term disability insurance.63What is (employer-paid) basicLTD insurance? 63What is (employee-paid) supplementalLTD insurance? 63What does supplemental LTDinsurance cost? 63How do I enroll in supplementalLTD insurance? 64When can I enroll in supplementalLTD insurance? 64What is considered a disability? 64What is the maximum benefit period? 64

Medical FSA and DCAP.65What is a Medical Flexible SpendingArrangement (FSA)? 65How does the Medical FSA work? 65What is the Dependent CareAssistance Program (DCAP)? 65When can I enroll in Medical FSA and DCAP? 65How do I enroll in Medical FSA and DCAP? 65When can I change my Medical FSAor DCAP election? 66SmartHealth.67Who is eligible for SmartHealth? 67What is the wellness incentivestarting in 2020? 67How do I qualify for the wellness incentivestarting in January 2020? 67What is my deadline to qualify for thewellness incentive? 67What if I don’t have internet access? 67SmartHealth contacts 67What happens to my health savings account(HSA) when coverage ends? 74What happens to my life insurancewhen coverage ends? 74Appeals.74How do I appeal a decision made by a plan? 74How do I appeal a decision from myemployer or the SEBB Program? 74How do I appeal a decision made by a SEBBAppeals presiding officer? 74How can I make sure my personal representativehas access to my health information? 74SEBB Program Nondiscrimination Noticeand Language Access Services.76Making changes in coverage.68How do I make changes in my health plancoverage? 68What changes can I make at any time? 68What changes can I make only duringannual open enrollment? 68What changes can I make during aspecial open enrollment? 68How do I make changes during aspecial open enrollment? 68What happens when my dependentloses eligibility? 71What happens to my dependent'scoverage if they die? 71What happens when I am required to providehealth plan coverage for a dependent? 72When SEBB Program coverage ends.72What are my options when coverage ends? 72What happens to my Medical FSA fundswhen coverage ends? 73What happens to my DCAP fundswhen coverage ends? 739

Get Started With SEBB My AccountSEBB My Account is the exclusive online enrollment system for the School Employees Benefits Board(SEBB) Program. Eligible school employees can use SEBB My Account on a computer, tablet, orsmartphone to enroll in benefits.What can I do in SEBB My Account? Enroll in SEBB benefits Waive SEBB medical Enroll your eligible dependents in SEBB benefits Upload documents to prove dependenteligibility Select your medical, dental, and vision plans Access vendor websites to enroll insupplemental (employee-paid) life andsupplemental accidental death anddismemberment insurance, a Medical FlexibleSpending Arrangement (FSA), and DependentCare Assistance Program (DCAP) Enroll in supplemental (employee-paid)long-term disability insurance Attest to premium surcharges (see the nextpage for details) Request a change due to a special openenrollmentLogin notes Google Chrome is the preferred browser, butEdge, Internet Explorer, Firefox, and Safari willalso work. Those enrolling in SEBB ContinuationCoverage must use the enrollment formsavailable at hca.wa.gov/erb under Forms& publications, or in the SEBB ContinuationCoverage Election Notice mailed to them. For more information, check out the Helpwith SEBB My Account page atmyaccount.hca.wa.gov.10Setting up your accountVisit myaccount.hca.wa.gov and click thegreen Login to SEBB My Account buttonunder Employee/Subscriber. You’ll be directedto SecureAccess Washington (SAW). See nextpage to learn about SAW.Click Sign up to create a SAW account. (Ifyou already have a SAW account, enter yourusername and password and skip to step 5.)Enter your name, email address, a username,and password. Remember to save yourusername and password in a safe place so youdon’t forget it the next time you log in.Check the box to indicate you’re not a robot,click Submit, and follow the link to activateyour account.Check your email for a message from SAW.Click on the confirmation link, then close theAccount Activated! browser window thatopens, and return to your original window.Follow the instructions on the screen to finishcreating your account.You will be redirected back to SEBB MyAccount. Enter your last name, date of birth,and last four digits of your Social Securitynumber. Click Verify my information.Select your security questions and answers.You’ll be directed to the SEBB My Accountdashboard.

How to enrollOnce you login to SEBB My Account, you canfollow the step-by-step tool at the top of the pageto guide you through the enrollment process. Thefour steps are:Add your dependents. Enter yourdependents’ information. If you are not addingdependents, you can skip to step 3.Verify your dependents. You must provideproof of your dependents’ eligibility.Upload documents from your computer ormobile device to verify your dependents’eligibility. Your documents must be verifiedand approved before your dependents areenrolled under your coverage. Acceptabledocuments (like a birth or marriage certificate,or recent tax return) and file types (PDF,JPEG, JPG or PNG) are listed in SEBB MyAccount.If you are unable to upload documentsonline, you can submit paper documentsto your payroll or benefits office. HCA mayaudit dependent eligibility determinations.Please make sure to keep the documents yousubmitted.What information do I need to enrolldependents?For your spouse, state-registered domesticpartner, or any children, you will need: NameDate of birthSocial Security numberVerification documentsA list of acceptable documents is available inSEBB My Account, as well as athca.wa.gov/sebb-employee and on page 14 ofthis enrollment guideSecureAccess WashingtonSecureAccess Washington (SAW) is the state’ssecure single sign-on portal for external users. ASAW account will keep your sensitive informationsecure. You can access multiple governmentservices online with a single user ID and passwordthat you create and manage yourself.Attest to the premium surcharges. Answera series of on-screen questions to determinewhether you’ll be charged the monthly 25-per-account tobacco use premiumsurcharge and, if applicable, the monthly 50spouse or state-registered domestic partnercoverage premium surcharge.Select your plans. You can follow a link toALEX, the online benefits advisor, to learnmore about which plans might be the best fitfor you. When you’re ready, select your plansin SEBB My Account by checking the boxnext to the medical, dental, and vision plansyou want for you and any dependents youwant to enroll.If you have other employer-based medicalcoverage, TRICARE, or Medicare, you canwaive SEBB medical coverage.When can I access SEBB My Account?Once your employer enters your name into SEBBMy Acccount, you can log in and enroll in benefits.Then, come back any time to check your coverageor request special open enrollment changes.11

EligibilityWho is eligible for SEBB benefits?This guide provides a summary of employeeeligibility for benefits administered by the SEBBProgram. Generally, you are eligible for theemployer contribution toward SEBB benefits if youwork in a school district or charter school, or area represented employee of an educational servicedistrict (ESD), and your employer anticipates youwill work at least 630 hours during the school year(September 1 through August 31). Paid holidaysdo not count toward the required hours, except forcertain circumstances when an employee is hiredlate in the school year.work pattern is revised. Your coverage begins thefirst day of the following month.If you are not anticipated to work 630 hours at thebeginning of the school year, but you do actuallywork 630 hours, you become eligible on the dayyou work your 630th hour. Your coverage beginsthe first day of the following month.If you are eligible for the employer contributiontoward SEBB benefits at the beginning of the year,but your work pattern is revised so that you areno longer anticipated to work 630 hours duringthe school year, your eligibility for the employercontribution and coverage end the last day of themonth in which the change is effective. See page 72for information about continuation coverage.Your employer will determine if you are eligible forthe employer contribution toward SEBB benefitsbased on your specific work circumstances(see Washington Administrative Code [WAC]182-31-040). All eligibility determinations are basedon rules in chapters 182-30 and 182-31 WAC. Ifdiscrepancies arise between WACs and this guide,the WACs take precedence. If you disagree with theeligibility determination, see Appeals on page 74.Eligibility based on hours worked theprevious two school yearsWhat if I'm eligible for SEBB benefits both asan employee and as a dependent?If your employer does not consider you eligibleafter having worked at least 630 hours the previoustwo school years, they must notify you, in writing, ofthe specific reason(s) why you are not anticipatedto work at least 630 hours in the current schoolyear. You have the right to appeal the eligibilitydetermination. See Appeals on page 74.You cannot enroll in medical, dental, or vision undertwo SEBB accounts. If you are an eligible employeeand are also eligible as a dependent under yourspouse’s, state-registered domestic partner’s, orparent’s account, you may choose one of theseoptions: Waive medical coverage under your ownaccount and, instead, enroll under your spouse’s,state-registered domestic partner’s, or parent’saccount. You must still enroll in dental, vision,basic life insurance, basic AD&D insurance, andbasic LTD insurance under your own account. Enroll in medical coverage under your ownaccount.Eligibility based on a revision to youranticipated work pattern or actual hoursworkedIf you are determined not eligible for the employercontribution toward SEBB benefits at the beginningof the school year, but your work circumstancechanges and your employer anticipates at that timethat you will work at least 630 hours during theschool year, you become eligible on the date your12If you worked at least 630 hours in each of theprevious two school years and are returning to thesame type of position or combination of positionswith the same school district, charter school, oreducational service district, you are presumedeligible for the employer contribution toward SEBBbenefits.Eligibility based on work within one district,charter school, or ESDAll of your hours worked as a school employeewithin the same school district or charter school, oras a represented employee of the same educationalservice district (ESD) count in the calculation ofhours to determine your eligibility. You cannot“stack” hours from different school districts, charterschools, or ESDs to reach the eligibility level of630 hours.Returning school employees haveuninterrupted coverageOnce you are enrolled in the SEBB Program, you willreceive uninterrupted coverage from one schoolyear to the next when you return at the start of thenext school year to the same school district, charterschool, or as a represented employee of the sameESD, as long as you are still anticipated to work 630hours in the coming school year.

Eligibility when changing jobs betweenSEBB organizationsOnce enrolled in the SEBB Program, you will haveuninterrupted coverage when moving from oneSEBB organization to another within the samemonth or a consecutive month if you are eligiblefor the employer contribution toward SEBB benefitsin the position you are leaving and are anticipatedto be eligible for the

Uniform Medical Plan (UMP), administered by Regence BlueShield (for medical questions) UMP Achieve 1, Achieve 2, High Deductible, UMP Plus . hca.wa.gov/sebb-employee to explore your options: Virtual be