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182-31-020  <<  182-31-030 >>   182-31-040

PDFWAC 182-31-030

What are the obligations of a school employees benefits board (SEBB) organization in the application of school employee eligibility?

(1) All school employees benefits board (SEBB) organizations must carry out all actions, policies, and guidance issued by the SEBB program which are necessary for the operation of benefit plans, education of school employees, claims administration, and appeals process including those described in chapters 182-30, 182-31, and 182-32 WAC. SEBB organizations must:
(a) Use the methods provided by the SEBB program to determine eligibility and enrollment in benefits;
(b) Provide eligibility determination reports with content and in a format designed and communicated by the SEBB program;
(c) Support SEBB program auditing of eligibility and enrollment decisions as needed; and
(d) Carry out corrective action and pay any penalties imposed by the health care authority (HCA) and established by the SEBB when the SEBB organization's eligibility determinations fail to comply with the criteria under these rules.
(2) SEBB organizations must determine school employee eligibility for SEBB benefits and the employer contribution according to the criteria in WAC 182-31-040 and 182-31-050. SEBB organizations must:
(a) Notify newly hired school employees of SEBB program rules and guidance for eligibility and appeal rights;
(b) Inform a school employee in writing whether or not they are eligible for SEBB benefits upon employment. The written communication must include information about the school employee's right to appeal eligibility and enrollment decisions;
(c) Routinely monitor all school employees work hours to establish eligibility and maintain the employer contribution toward SEBB benefits coverage;
(d) Identify when a previously ineligible school employee becomes eligible or a previously eligible school employee loses eligibility; and
(e) Inform a school employee in writing whether or not they are eligible for benefits and the employer contribution whenever there is a change in work patterns such that the school employee's eligibility status changes. Whenever this occurs, SEBB organizations must inform the school employee of the right to appeal eligibility and enrollment decisions.
(3) SEBB organizations must determine school employee's dependents eligibility for SEBB benefits according to the criteria in WAC 182-31-140.
[Statutory Authority: RCW 41.05.021, 41.05.160, 2017 3rd sp.s. c 13, 2018 c 260, and SEBB policy resolutions. WSR 19-14-093 (Admin #2019-01), § 182-31-030, filed 7/1/19, effective 8/1/19. Statutory Authority: RCW 41.05.021, 41.05.160 and SEBB policy resolutions. WSR 19-01-055 (Admin #2018-01), § 182-31-030, filed 12/14/18, effective 1/14/19.]
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