A school employee who is
eligible to participate in the salary reduction plan may enroll or revoke their
election and make a new election under the premium payment plan, FSA, limited
purpose FSA, or DCAP outside of the annual open enrollment if a special open
enrollment event occurs. The enrollment or change in election must be allowable
under Internal Revenue Code (IRC) and Treasury regulations, and correspond to
and be consistent with the event that creates the special open enrollment. To
make a change or enroll, the school employee must submit the required form to
their SEBB organization. The SEBB organization must receive the required form
and evidence of the event that created the special open enrollment no later
than 60 days after the event occurs.
For purposes of this section, an eligible dependent includes
any person who qualifies as a dependent of the school employee for tax purposes
under IRC 26 U.S.C. Sec.
152 without regard to the income limitations
of that section. It does not include a state registered domestic partner unless
the state registered domestic partner otherwise qualifies as a dependent for
tax purposes under IRC 26
U.S.C. Sec. 152.
(a)
Premium payment plan. A
school employee may enroll or revoke their election and elect to opt out of the
premium payment plan when any of the following special open enrollment events
occur, if the requested change corresponds to and is consistent with the event.
The enrollment or election to opt out will be effective the first day of the
month following the later of the event date or the date the required form is
received. If that day is the first of the month, the enrollment or change in
election begins on that day. If the special open enrollment is due to the
birth, adoption, or assumption of legal obligation for total or partial support
in anticipation of adoption of a child, the enrollment or change in election
will begin the first of the month in which the event occurs.
(i) School employee acquires a new dependent
due to:
* Marriage;
* Registering a state registered domestic partnership when
the dependent is a tax dependent of the school employee;
* Birth, adoption, or when the school employee has assumed a
legal obligation for total or partial support in anticipation of adoption;
or
* A child becoming eligible as an extended dependent through
legal custody or legal guardianship.
(ii) School employee's dependent no longer
meets SEBB eligibility criteria because:
* School employee has a change in marital status;
* School employee's domestic partnership with a state
registered domestic partner who is a tax dependent is dissolved or
terminated;
* An eligible dependent child turns age 26 or otherwise does
not meet dependent child eligibility criteria;
* An eligible dependent ceases to be eligible as an extended
dependent or as a dependent with a disability; or
* An eligible dependent dies.
(iii) School employee or a school employee's
dependent loses other coverage under a group health plan or through health
insurance coverage, as defined by Health Insurance Portability and
Accountability Act (HIPAA);
(iv)
School employee has a change in employment status that affects the school
employee's eligibility for their employer contribution toward their
employer-based group health plan;
(v) The school employee's dependent has a
change in their own employment status that affects their eligibility or their
dependent's eligibility for the employer contribution toward their
employer-based group health plan;
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Exception:
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As used in (a)(v) of this subsection, "employer
contribution" means contributions made by the dependent's current or former
employer toward health coverage as described in Treasury Regulation
26 C.F.R.
54.9801-6.
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(vi)
School employee or a school employee's dependent has a change in enrollment
under an employer-based group health plan during its annual open enrollment
that does not align with the SEBB annual open enrollment;
(vii) School employee or a school employee's
dependent has a change in residence that affects health plan availability. If
the school employee has a change in residence and the school employee's current
medical plan is no longer available, the school employee must select a new
medical plan as described in WAC
182-30-085(3);
(viii) School employee's dependent has a
change in residence from outside of the United States to within the United
States, or from within the United States to outside of the United States, and
that change in residence resulted in the dependent losing their health
insurance;
(ix) A court order
requires the school employee or any other individual to provide insurance
coverage for an eligible dependent of the school employee (a former spouse or
former state registered domestic partner is not an eligible
dependent);
(x) School employee or
a school employee's dependent enrolls in coverage under medicaid or a state
children's health insurance program (CHIP), or the school employee or a school
employee's dependent loses eligibility for coverage under medicaid or
CHIP;
(xi) School employee or a
school employee's dependent becomes eligible for state premium assistance
subsidy for SEBB health plan coverage from medicaid or CHIP;
(xii) School employee or a school employee's
dependent enrolls in coverage under medicare or the school employee or a school
employee's dependent loses eligibility for coverage under medicare;
(xiii) School employee or a school employee's
dependent's current medical plan becomes unavailable because the school
employee or enrolled dependent is no longer eligible for a HSA. The HCA may
require evidence that the school employee or a school employee's dependent is
no longer eligible for a HSA;
(xiv)
School employee or a school employee's dependent experiences a disruption of
care for active and ongoing treatment, that could function as a reduction in
benefits for the school employee or a school employee's dependent. The school
employee may not change their health plan election if the school employee's or
dependent's physician stops participation with the school employee's health
plan unless the SEBB program determines that a continuity of care issue exists.
The SEBB program will consider but not limit its consideration to the
following:
* Active cancer treatment such as chemotherapy or radiation
therapy;
* Treatment following a recent organ transplant;
* A scheduled surgery;
* Recent major surgery still within the postoperative period;
or
* Treatment for a high-risk pregnancy.
(xv) School employee or school employee's
dependent becomes eligible and enrolls in a TRICARE plan, or loses eligibility
for a TRI-CARE plan.
(xvi) School
employee has a change in employment location that affects medical plan
availability.
If the school employee changes employment locations and their
current medical plan is no longer available, the school employee must select a
new medical plan as described in WAC
182-30-085(3).
If the school employee has one or more new medical plans
available, the school employee may select to enroll in a newly available
plan.
(xvii) The SEBB
program determines that there has been a substantial decrease in the providers
available under a SEBB medical plan.
If the school employee is having premiums taken from payroll
on a pretax basis, a medical plan change will not be approved if it would
conflict with provisions of the salary reduction plan authorized under
RCW
41.05.300.
(b)
FSA and limited purpose FSA.
A school employee may enroll or revoke their election and make a new election
under the FSA or limited purpose FSA when any one of the following special open
enrollment events occur, if the requested change corresponds to and is
consistent with the event. The enrollment or new election will be effective the
first day of the month following the later of the event date or the date the
required form and evidence of the event that created the special open
enrollment is received by the SEBB organization. If that day is the first of
the month, the enrollment or change in election begins on that day. If the
special open enrollment is due to the birth, adoption, or assumption of legal
obligation for total or partial support in anticipation of adoption of a child,
the enrollment or change in election will begin the first of the month in which
the event occurs.
(i) School employee
acquires a new dependent due to:
* Marriage;
* Registering a state registered domestic partnership when
the dependent is a tax dependent of the school employee;
* Birth, adoption, or when the school employee has assumed a
legal obligation for total or partial support in anticipation of adoption;
or
* A child becoming eligible as an extended dependent through
legal custody or legal guardianship.
(ii) School employee's dependent no longer
meets SEBB eligibility criteria because:
* School employee has a change in marital status;
* School employee's domestic partnership with a state
registered domestic partner who qualifies as a tax dependent is dissolved or
terminated;
* An eligible dependent child turns age 26 or otherwise does
not meet dependent child eligibility criteria;
* An eligible dependent ceases to be eligible as an extended
dependent or as a dependent with a disability; or
* An eligible dependent dies.
(iii) School employee or a school employee's
dependent loses other coverage under a group health plan or through health
insurance coverage, as defined by HIPAA;
(iv) School employee or a school employee's
dependent has a change in employment status that affects the school employee's
or a dependent's eligibility for the FSA or limited purpose FSA;
(v) A court order requires the school
employee or any other individual to provide insurance coverage for an eligible
dependent of the school employee (a former spouse or former state registered
domestic partner is not an eligible dependent);
(vi) School employee or a school employee's
dependent enrolls in coverage under medicaid or CHIP, or the school employee or
a school employee's dependent loses eligibility for coverage under medicaid or
CHIP;
(vii) School employee or a
school employee's dependent enrolls in coverage under medicare.
(c)
DCAP. A school
employee may enroll or revoke their election and make a new election under the
DCAP when any one of the following special open enrollment events occur, if the
requested change corresponds to and is consistent with the event. The
enrollment or new election will be effective the first day of the month
following the later of the event date or the date the required form and
evidence of the event that created the special open enrollment is received by
the SEBB organization. If that day is the first of the month, the enrollment or
change in election begins on that day. If the special open enrollment is due to
the birth, adoption, or assumption of legal obligation for total or partial
support in anticipation of adoption of a child, the enrollment or change in
election will begin the first of the month in which the event occurs.
(i) School employee acquires a new dependent
due to:
* Marriage;
* Registering a state registered domestic partnership if the
state registered domestic partner qualifies as a tax dependent of the school
employee;
* Birth, adoption, or when the school employee has assumed a
legal obligation for total or partial support in anticipation of adoption;
or
* A child becoming eligible as an extended dependent through
legal custody or legal guardianship.
(ii) School employee or a school employee's
dependent has a change in employment status that affects the school employee's
or a dependent's eligibility for DCAP;
(iii) School employee or school employee's
dependent has a change in enrollment under an employer-based DCAP during its
annual open enrollment that does not align with the SEBB annual open
enrollment;
(iv) School employee
changes dependent care provider; the change to the DCAP election amount can
reflect the cost of the new provider;
(v) School employee or school employee's
spouse experiences a change in the number of qualifying individuals as defined
in IRC 26 U.S.C. Sec.
21 (b)(1);
(vi) School employee's dependent care
provider imposes a change in the cost of dependent care; school employee may
make a change in the DCAP election amount to reflect the new cost if the
dependent care provider is not a qualifying relative of the school employee as
defined in IRC 26 U.S.C.
Sec.
152.
