SEBB My Account - Special Open Enrollment - Employee User Guide

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SEBB My Account Special OpenEnrollment User Guide for employeesA special open enrollment (SOE) can be created for specific lifeeventsCertain events let you make account changes (like changing plans or enrolling a dependent) outside ofan annual open enrollment or your initial enrollment period. Gaining initial eligibility for SEBB benefits isnot considered a special open enrollment event.You must provide proof of the event that created the special open enrollment (for example, a marriageor birth certificate) along with the required enrollment/change forms in SEBB My Account or to yourpayroll or benefits office, no later than 60 days after the event. For more information please see SEBBAdministrative Policy 45-2 and Addendum 45-2A. Addendum 45-2A provides further details oneligibility documentation required specific to the event.The table below indicates some of the allowable changes for each SOE event.If this event happensAdd ange SEBBmedical, dentaland/or visionplanYesYesEnroll afterwaiving SEBBmedicalcoverageYesMarriage, registering adomestic partner, birth,adoption, or assuming alegal obligation for totalor partial support inanticipation of adoptionChild becomes eligible asan extended dependentthrough legal custody orlegal guardianshipEmployee or dependentloses eligibility for othercoverage under a grouphealth plan or throughhealth insurance, asdefined by the HealthInsurance Portability andAccountability Act (HIPAA)Employee has a change inemployment status thataffects the employee'seligibility for theiremployer contributiontoward their employerbased group health planYes1YesNoYesNoYesYesNoYesNoYesYesYesYesYesYes1

If this event happensAdd nge SEBBmedical, dentaland/or visionplanYesYesEnroll afterwaiving SEBBmedicalcoverageYesEmployee's dependent hasa change in theiremployment status thataffects their eligibility forthe employer contributionunder their employerbased group health planEmployee has a change inemployment from a SEBBorganization to a publicschool district thatstraddles county lines or isin a county that boardersIdaho or Oregon, whichresults in having differentmedical plans available.Employee or dependenthas a change in enrollmentunder another employerbased group health planduring its annual openenrollment that does notalign with the SEBBProgram’s annual openenrollment.Employee's dependentmoves from outside theUnited States to live withinthe United States, or fromwithin the United States tolive outside of the UnitedStates, and that change inresidence results in thedependent losing theirhealth insurance.Employee or dependenthas a change in residencethat affects health planavailability.A court order requires theemployee or any otherindividual to provide ahealth plan for an eligiblechild of the NoNoYesNoNoYesYesYesNoYes2

If this event happensAdd nge SEBBmedical, dentaland/or visionplanYesYesEnroll afterwaiving SEBBmedicalcoverageYesEmployee or dependentbecomes entitled to orloses eligibility for AppleHealth (Medicaid) or astate Children’s HealthInsurance Program (CHIP).Employee or a dependentbecomes eligible for astate premium assistancesubsidy for SEBBhealth plan from AppleHealth (Medicaid) or astate CHIP.Employee or anemployee's dependentbecomes entitled tocoverage under Medicare,or the employee oremployee's dependentloses eligibility forcoverage under Medicare.Employee's or dependent’scurrent health planbecomes unavailablebecause the employee ordependent is no longereligible for a HealthSavings Account (HSA).Employee or dependentexperiences a disruption ofcare that could function asa reduction in benefits forthe employee or theirdependent for a specificcondition or ongoingcourse of treatment(requires approval by theSEBB Program).Employee or dependentbecomes eligible andenrolls in a TRICARE plan,or loses eligibility for aTRICARE es, if approvedby SEBBNoNoNoNoNoYesYesSubscriber may add only the new spouse, state-registered domestic partner, or children of thespouse or partner. Existing dependents may not be added.1Subscriber may only remove a dependent from SEBB coverage if the dependent enrolls in the newspouse's or state-registered domestic partner's plan.23

Available special open enrollments that can be submitted via SEBBMy Account MarriageRegistering a state registered domestic partnershipBirth or adoptionNewly eligible extended dependentDependent loses eligibilityLoss of other coverageChange in employment status (dependent)Change in school districtChange under other employer-based group health plan’s open enrollmentDependent moves from outside USA to USA, or from USA to outside USAChange in residence (Subscriber must notify district to update address in SEBB My Account fornew plan elections)Court orderGain or lose eligibility for Medicaid or CHIPBecome eligible for state premium assistance subsidy for SEBB health plan coverage fromMedicaid or CHIPGain or lose eligibility for MedicareHealth plan becomes unavailableContinuity of careGain or lose eligibility for Tricare4

Special Open Enrollment steps in SEBB My Account1. Select ‘Special open enrollment’ from the dashboard.5

2. View the available special open enrollment events (SOE) from the drop-down list.a. Select the SOE applicable to your life event.b. Enter the date of the event, in this case the date of birth for a newborn.c. Select the “Submit” button to create the event.6

3. The enrollment period (the time you have to complete your SOE request) is 60 days from thedate of the event and is displayed on the screen. The current status will show as pending. Ifthe event was created in error, select ‘Delete’ and start over.The available actions specific to the event selected are now visible. Actions available willdiffer by the special open enrollment event selected. If the event allows for adding adependent, you will be presented with an initial question “Are you adding dependent(s) aspart of this SOE request?a. Select the desired action, in this case the family is adding a newborn dependent.4. Click on Step 1, Add Dependentsa. A list of your current dependents (including yourself) will display, select ‘AddDependent.’b. Fill in demographic information for the new dependent (i.e, last name, first name,etc.).i. If the dependent does not have a social security number then check the box‘This person currently has no social security number’. A social security numberwill be required at later date.7

c. Select relationship to the subscriber (the employee) and qualifying reason.d. Submit changes, and confirm.8

5. Click on Step 2, Submit documentation for proof of the special open enrollment event and ifnecessary, dependent eligibility.a. Select ‘Submit documentation for dependent(s).i. Links to accepted documents are provided.b. Select files to choose a file to upload.c. Select document type.d. Select which dependent this applies to and the special open enrollment.e. Upload document, and confirm.Alternatively, the eligibility documentation can be submitted in paper form to your benefitsadministrator. Submitting electronically in SEBB My Account allows for your benefits administrator toreview and approve in SEBB My Account, expediting this process.9

6. Click on Step 3, Make attestations as appropriate.a. Select ‘Make attestations.’b. Complete the tobacco and spousal premium surcharge attestations as appropriate,and Continue.10

7. Verify health plans/add coverage for new dependent.First, verify/update health plan elections by clicking on ‘Make plan elections’. Second, in order toenroll the dependent in medical, dental, and/or vision select from drop down ‘Yes’ for each typeof coverage you would like to enroll dependent in.11

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8. Once all confirmations are made on plan changes and/or health plan elections fordependent(s), a Summary of Coverage Elections can be downloaded.Summary of Coverage Elections reflects the elections made, but are not necessarily in effectuntil SOE is approved by benefits administrator.9. Once all steps have been completed, the Submit button will be engaged. Once you selectSubmit, the request will go to your Benefit Administrator to review and verify.a. Once the event has been submitted, you will see the status change to Submitted.Further, you can expand the event, and review the actions you have taken as part ofyour SOE.13

Employee or an employee's dependent becomes entitled to coverage under Medicare, or the employee or employee's dependent loses eligibility for coverage under Medicare. No No Yes Yes Yes Employee's or dependent's current health plan becomes una vailable because the employee or dependent is no longer eligible for a Health Savings Account (HSA).

Related Documents:

your health plan and other insurance options by attending one of the SEBB Program benefits fairs. All are from 4 to 7 p.m., except Pasco, which is 3 to 6 . hca.wa.gov/sebb-employee. hca.wa.gov/sebb-employee. sebb.naviabenefits.com. page 8. hca.wa.gov/sebb-oe. 6 Who to contact for help

limited to a single enrollment in medical and dental plans (PEBB Program) or medical, dental, and vision (SEBB Program). If they are a PEBB employee who waives PEBB medical and dental for SEBB medical, they must also enroll in SEBB dental and vision. Relationship to subscriber 1 This field is required for health care services.

Address changes must be submitted to your payroll or benefits office. Document upload Use this tile to upload your dependent verification documents and proof of a special open enrollment event. Revised 7.30.2020 SEBB My Account User Guide 13 Premium surcharge attestations Use this tile to

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The purpose of this Benefits Administrator manual is to provide you with, but not limited to most commonly used terminologies, eligibility information and screens you will see in SEBB My Account. The intent is to assist you with understanding the employee information that affects the Health Care Authority (HCA) SEBB Program insurance coverage. The

You are eligible for the Medical FSA if you meet criteria listed in Washington Administrative Code (WAC) 182-31-040. A link to the WAC is available at hca.wa.gov/sebb-rules. Generally, the Medical FSA is available to school employees who are ex

The chart below briefly compares the medical deductibles and per-visit out-of-pocket costs of some in-network benefits for SEBB medical plans. Copays and coinsurances may apply; some copays and coinsurance do not apply until after you have paid your annual deductibles.

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