Healthcare Changes

The State of Washington is taking over the health plans for medical, dental and vision care for all school employees across the state effective Jan. 1, 2020. This new insurance program, managed by the School Employees Benefits Board (SEBB) of the Washington State Health Care Authority, will have open enrollment between Oct. 1 and Nov. 15, 2019.

SEBB aims to standardize benefits, rules, and costs for those working in K-12 education across the state. All staff who work at least 630 hours in a school year qualify for full benefits. You must choose a benefits plan or waive coverage to not be automatically enrolled in a plan by the state.

There are many significant changes to your healthcare coverage resulting from this transition to SEBB and the district is here to support and guide you and your families through this process.

Open Enrollment Support Schedule

  • Nov. 14 — Enrollment Assistance Event (open to all staff), RSD Administration Building 11:30 a.m. to 4:30 p.m.
  • Nov. 15 — Enrollment Assistance Event (open to all staff), RSD Administration Building 11:30 a.m. to 4:30 p.m.

Critical Coverage Clarification

The Premera network being offered under the School Employee Benefits Board (SEBB) starting Jan. 1 is not the same Premera network we have now. The Premera network under SEBB is called Heritage Prime, which is a more exclusive network and does not contract with Providence-owned facilities, which includes Kadlec.

This means that Kadlec and its clinics will not be in-network for anyone on a Premera plan after Jan. 1 and they will be billed the out-of-network cost for services.

Trios Health in Kennewick and Lourdes Medical Center in Pasco are the only in-network hospital options in the Tri-Cities for staff choosing a SEBB Premera plan.

The Kaiser Permanente plans also have Kadlec, Lourdes and their respective clinics included in its network. The Uniform Medical Plans (UMP) will have Kadlec, Lourdes, Trios and their respective clinics in its network.

To ensure that your preferred physician or clinic is in-network, please use the links to provider directories in the tabs below.

Medical Plan Premiums

Kaiser Permanente

Kaiser Permanente WA — (888) 901-4636

Plans Employee Employee & Spouse Employee & child(ren) Employee, spouse & child(ren)
Core 1 (Summary) $13 $26 $23 $39
Core 2 (Summary) $19 $38 $33 $57
Core 3 (Summary) $89 $178 $156 $267

 

Before you enroll

Contact the plan or check the plan's provider directory to make sure your providers are in the plan's network.

Surcharges in addition to medical plan premiums

You will pay the following surcharges in addition to your monthly medical premium if they apply to you.

  • A monthly $25-per-account surcharge will apply if you or any dependent enrolled in SEBB medical coverage uses tobacco products.
  • A monthly $50 surcharge will apply if you enroll your spouse or state-registered domestic partner in SEBB medical coverage and your spouse or domestic partner has chosen not to enroll in other employer-based group medical insurance that is comparable to the PEBB Program's Uniform Medical Plan (UMP) Classic.

For more details, visit the state Health Care Authority's Surcharges page.

Premiums for other benefits

There are no employee premiums for dental, vision, basic life and accidental death and dismemberment (AD&D) insurance, and basic long-term (LTD) disability insurance benefits.

Forms and publications

Related links

 

Premera

Premera — (800) 807-7310

Plans Employee Employee & Spouse Employee & child(ren) Employee, spouse & child(ren)
High PPO (Summary) $70 $140 $123 $210
Standard PPO (Summary) $22 $44 $39 $66

 

Before you enroll

Contact the plan or check the plan's provider directory to make sure your providers are in the plan's network.

Surcharges in addition to medical plan premiums

You will pay the following surcharges in addition to your monthly medical premium if they apply to you.

  • A monthly $25-per-account surcharge will apply if you or any dependent enrolled in SEBB medical coverage uses tobacco products.
  • A monthly $50 surcharge will apply if you enroll your spouse or state-registered domestic partner in SEBB medical coverage and your spouse or domestic partner has chosen not to enroll in other employer-based group medical insurance that is comparable to the PEBB Program's Uniform Medical Plan (UMP) Classic.

For more details, visit the state Health Care Authority's Surcharges page.

Premiums for other benefits

There are no employee premiums for dental, vision, basic life and accidental death and dismemberment (AD&D) insurance, and basic long-term (LTD) disability insurance benefits.

Forms and publications

Related links

Uniform Medical Plan (UMP)

Uniform Medical Plan (UMP) — (800) 628-3481

Plans Employee Employee & Spouse Employee & child(ren) Employee, spouse & child(ren)
Achieve 1 (Summary) $33 $66 $58 $99
Achieve 2 (Summary) $98 $196 $172 $294
High Deductible (Summary) $25 $50 $44 $75

 

Before you enroll

Contact the plan or check the plan's provider directory to make sure your providers are in the plan's network.

Surcharges in addition to medical plan premiums

You will pay the following surcharges in addition to your monthly medical premium if they apply to you.

  • A monthly $25-per-account surcharge will apply if you or any dependent enrolled in SEBB medical coverage uses tobacco products.
  • A monthly $50 surcharge will apply if you enroll your spouse or state-registered domestic partner in SEBB medical coverage and your spouse or domestic partner has chosen not to enroll in other employer-based group medical insurance that is comparable to the PEBB Program's Uniform Medical Plan (UMP) Classic.

For more details, visit the state Health Care Authority's Surcharges page.

Premiums for other benefits

There are no employee premiums for dental, vision, basic life and accidental death and dismemberment (AD&D) insurance, and basic long-term (LTD) disability insurance benefits.

Forms and publications

Related links

Resources

Frequently Asked Questions

What is the District's contribution to my benefits?

The employer contribution to employee benefits is $994 from January 1, 2020 - June 30, 2020 and $1,056 thereafter for every school district employee in every district in the state. These contribution rates are set at the state level and do NOT change based on the employee's plan choice. If an employee waives their medical coverage or chooses the most expensive medical plan, the district contributions remains the same and payments go directly to SEBB. 

What happens if I don't enroll during Open Enrollment (Oct 1st-Nov 15th)?

The state will default you in to specific medical, dental, and vision plans without your consent and you will be responsible for your out-of-pocket expenses. There will be no option to make changes or opt out of medical until the next benefit year. The state will also impose the $25 per month tobacco surcharge for anyone who “defaults” by not enrolling (See below). It is very important that every benefit-eligible employee complete the open enrollment process starting Oct. 1.

I have never taken District Medical insurance, can I continue to do so?

Yes, if you have other employer-based group medical insurance, such as TRICARE, or Medicare. If you have Medicaid (Apple Health), you have to sign up for SEBB Medical coverage through the district. If you’re eligible to waive medical you still have to take the mandatory coverage benefits – dental, vision, life insurance and long-term disability (LTD).

What does SEBB cover?

SEBB will replace our current medical, dental, vision, life insurance, accidental death & dismemberment (AD&D), salary insurance (long-term disability or LTD), Flex Spending (medical and dependent care) accounts, and HSA (health savings account).

How is SEBB coverage different from what I currently have?

Our medical options will include three Kaiser plans, two Premera/Blue Cross, and three Uniform Medical Plans (UMP). We’ll have three dental options—Willamette, Delta Care (managed care plan), and Uniform Dental Plan. The three vision options will be Davis Vision, EyeMed, and MetLife. 

Can I keep my current doctors?

Probably but not guaranteed. The Kaiser/Premera plans are different from what we currently have. Before picking a plan you may want to contact your doctor’s office to confirm that they’ll take the insurance you are considering.

Provider Search

Can I keep my current dentist(s)?

Before selecting a plan, you may want to contact your dentist’s office to confirm that they accept the insurance plan you are considering.  Willamette Dental will still be an option.  If you are not currently a Willamette patient but are considering switching to them, please contact them to make sure they’re taking new patients. Delta Care has only 6 locations in our area while Uniform Dental Plan is most like our current Sun Life dental plan.

Provider Search

Can I keep my current vision doctor(s)?

There will be three options for vision, it will depend on what plan you choose.

Provider Search

What about orthodontics?

If your orthodontics are being done through Willamette you’ll want to stay with Willamette, otherwise most of the orthodontists in our area should take Uniform Dental Plan.

Provider Search

Are there caps to life insurance?

There will a mandatory life insurance policy of $35,000 but through MetLife you can get up to $500,000 in additional coverage for yourself and $100,000 and $25,000 for children from 2 weeks to 26 years old with no physical (this open enrollment period only.)

What is SEBB My Account and how do I set up my account?

SEBB My Account is where you will be able to enroll or waive your benefits, enroll and verify your dependents, select your coverage plans and more. There are six steps to setting up your account:

  1. Visit myaccount.hca.wa.gov and click the green “Login To SEBB My Account” button under Employee/Subscriber. This will take you to SecureAccess Washington (SAW), the state’s secure single-sign on portal.
     
  2. Click “Sign up” to create a SAW account (if you already have a SAW account, enter your username and password and skip to Step 5). Enter your name, email address, a username and password. Remember to save your username and password in a safe place so you don’t forget it.
     
  3. Check the box to indicate you’re not a robot, click “Submit” and follow the link to activate your account.
     
  4. Check your email for a message from SAW. Click the confirmation link in that message then close the “Account Activated!” browser window that opens and return to your original window. Follow the instructions on the screen to finish creating your account.
     
  5. You will be redirected to SEBB My Account. Enter your last name, date of birth, and last four digits of your Social Security number. Click “Verify My Information.”
     
  6. Select your security questions and answers. You’ll then be directed to the SEBB My Account dashboard.

Getting Started With SEBB Guide

Does this mean that the state will have my personal medical information?

They will have your enrollment information (including verification of dependents) but there are optional choices as well, such as the new state wellness program.  HIPAA laws still apply. If you plan to take part in their Wellness Program, SEBB will only have the information you choose to share with them.

What will this cost me?

The cost will depend on what medical plan you pick and who you are covering on your insurance. Overall, for 2019-2020, full family and employee/child(ren) rates are lower than last year, while single-payer employee plans are a bit higher. This is not set by the district.

Medical, Life Insurance & Long-Term Disability Plan Rates

What happens to my medical pooling?

Pooling is still happening but now at the state level. The state estimates how many employees will waive coverage. Factoring in the expectation that some employees will waive medical coverage allows them to offer consistent, affordable employee monthly premiums throughout the year.

Can I continue to use Apple Health?

If you work 630 hours in a contract year, neither you nor your dependents will be able to have Apple Health.

How does this impact my contract?

Changes to insurance are a mandatory subject of bargaining. The district will be meeting with our various unions this fall to address impacts.

Are there additional services I can purchase?

Through SEBB, you can get FLEX Medical and Dependent Care and a health savings account (HSA). You may also purchase additional long-term disability (LTD) and AD&D.

How is long-term disability going to work?

SEBB has a mandatory long-term disability (LTD) benefit of $400 per month. It is our understanding that you will have the option to purchase more as a payroll deduction.

How is short-term disability going to work?

SEBB will use the new Washington Family Medical Leave starting Jan. 1, 2020 for short-term disability (STD). We will no longer be able to offer STD through the district.

What happens to my pre-tax Section 125 process?

American Fidelity will still be offering most of their Section 125 (Cancer, Accident, etc.) However now that Flex (Medical and Dependent Care) Spending Accounts, HSAs, and life insurance are covered under the SEBB umbrella, we will not be able to offer as payroll deductions any similar American Fidelity plan. You can contact American Fidelity to continue your life insurance as a self-pay.

Are there hidden costs?

  • Tobacco surcharge: A monthly $25 premium surcharge per account if the employee or any dependent (age 13 or older) enrolled on their SEBB medical plan uses a tobacco product.
  • Spouse or State-Registered Domestic Partner coverage premium surcharge: A monthly $50 premium surcharge if the employee has a spouse or state-registered domestic partner enrolled on their SEBB medical plan, and the spouse or state-registered domestic partner has elected not to enroll in their employer-based group medical insurance that is comparable to PEBB’s Uniform Medical Plan

2019 Premium Surcharge Help Sheet

Where can I access plan information?

Is it true I can receive benefits if I work as a coach and/or substiute?

Yes. If you reach 630 cumulative hours per year in one job or across multiple RSD jobs, the benefits office will contact you to set up benefits, just like everyone else.

Can I waive medical, dental, vision or other benefits?

You have to take dental, vision, life insurance and long-term disability benefits. Other benefits may be waived.

Will I still be able cover all my dependents, such as my children and/or stepchildren?

The state will require verification of all dependents you plan to cover. This will include proof of marriage, birth certificates, and/or tax returns. The district will have opportunities to help you with the verification process. This is required by the state for coverage.

How To Check Dependent Verification

Is there dual enrollment/double coverage in SEBB?

If both employees work for school districts, charter schools, or ESDs in Washington State, no one will be allowed to have double coverage within SEBB.  However, if your spouse works elsewhere you and/or your dependents can be double covered (surcharges may apply.)