SEBB appeals contact information

The Health Care Authority has set up a number to call regarding expedited appeals for urgent medical  needs. 

Effective immediately, you can call 1-800-200-1004, menu option 7, between 8 a.m. and 4:30 p.m. Monday through Friday to:

  • Learn whether your appeal has been received.
  • Request to expedite review of your appeal if you or a dependent have an urgent medical need.

Please keep in mind that call wait times may be longer than usual due to the high volume of appeals. Until all appeals are logged in, HCA records may not show your appeal as being received yet. HCA's goal is to process all approved appeals that do not need additional action by a school employee by mid-January.  Please do not resubmit your appeal until all appeals have been processed.

Managing the Transition to SEBB 

Prescriptions 

Did you know that not all pharmacies are not part of the Uniform Medical Plan network?

It’s a good idea to make sure your pharmacy is in network. If not, you can move your prescriptions to an in-network pharmacy in December. Be sure that the new pharmacy is in network with your current insurance carrier too. In most cases the new pharmacy can simply contact your current pharmacy and transfer your prescriptions to them. To see if your current pharmacy is in network, contact your new insurance company:

  • For the Uniform Medical Plan or call:1-888-361-1611
  • For Premera call 1-800-807-7310
  • For all Kaiser plans call 1-800-728-2779 before Jan.1. After Jan, 1, call 1-888-901-4636, unless you are in southwest Washington, then call 503-813-2000. 

Transition of care

If you are in the middle of treatment you will want to consult you doctor to make sure that all steps are taken to ensure that there isn’t an interruption of care. 

Call customer service for the plan you signed up for now to make sure you know what steps need to be taken to ensure that everything goes smoothly on January 1.

Now is a great time to work with your doctor to get the procedure authorized with your new plan.

Check your networks

If you didn’t verify that your doctors were in network during open enrollment now is the time to do that. Your new plan customer service department can help you with this to make sure you don’t have any surprises. If your healthcare provider is not in their network be sure to ask them how you can request that a provider be added.

  • For the Uniform Medical Plan or call:1-888-361-1611
  • For Premera call 1-800-807-7310
  • For all Kaiser plans, or call 1-800-728-2779 before Jan. 1. After Jan, 1, call 1-888-901-4636, unless you are in southwest Washington, then call 503-813-2000. 

Dental benefits

Some people may notice a difference in their dental coverage. The Uniform Dental Plan, through Delta Dental, has cost shares for some services, e.g. fillings, crowns and root canals. If you are expecting to receive any of these services, you may want to contact the insurance company to find out your anticipated cost share and to see if any prior authorization is needed. Note: If you signed up for an FSA you can use it for dental expenses.

If you are in the middle of orthodontia treatment, contact your new plan to see what benefits may be available.

The state's SEBB enrollment guide is now available!

The Legislature has approved and funded a new health care system for K-12 school employees that begins in January 2020. The new School Employees Benefits Board (SEBB) program will replace the existing health insurance negotiated locally in each school district. That means all K-12 public school employees will have a new insurance plan beginning next year.

Map of Plans

This map shows which insurance carriers are offering plans in which counties. This chart shows the health insurance plans offered by county, including out-of-pocket premiums. The Uniform Medical Plan (UMP) is insurance offered directly by the state, while Kaiser and Premera are private insurance companies. Plan options are based on where you live, except you may be able to choose from additional plans if your district straddles county lines or is in a county that borders Idaho or Oregon.

Eligibility Notification

School districts should have notified employees if they are eligible for SEBB coverage. If you need to appeal the decision, you must do so within 30 days from when you were notified. Here's how to file an appeal, and here is the appeal form you must use

Information and Resources

Background

In 2017, as part of the overall McCleary school funding package, the Legislature created a new state-run School Employees Benefit Board (SEBB) health insurance program to replace the existing district-by-district system of negotiating health care benefits. The SEBB is modeled on a similar but separate insurance program for public employees that has existed for years.

During summer/fall of 2018, representatives from school employee unions negotiated a tentative agreement with the Office of Financial Management (OFM). WEA played a key leadership role and helped negotiate a deal that will benefit educators and reduce the price of insurance for many. WEA has two of the four members representing labor on the SEBB. The other two are from PSE and SEIU 925, unions that represent classified school employees.

Highlights of the changes

Below are key features either required by law or bargained, and which help explain why the WEA Board ratified the agreement.

  • Part-time employees who work on average of 3.5 hours per day, or 630 hours per year, will now receive the same coverage as superintendents and other full-time staff. This means many of our ESP members, who work fewer hours and make less money, will finally have access to affordable health care, possibly for the first time ever.
  • By law, family premiums under the new SEBB system cannot exceed three times the rate for an individual employee, which will result in significant savings for many families and will make family coverage affordable to others who currently cannot afford it.
  • Some individuals may see some cost increases. However, under the negotiated agreement, the employer is required to pay 85 percent of the cost for health care premiums on average. This is based on a typical plan in the SEBB program, similar to WEA Select Plan 2. Employees would pay approximately 15 percent of the premium for this typical plan. Even though costs may go up, the guaranteed employer share for eligible part- and full-time employees will limit the size of any increase to the employee.
  • While the SEBB will be run by the state, participating employees will still choose from a variety of private insurance programs, including Kaiser and Premera. Here is a chart that shows plan benefits and costs by county.

Because the current system is negotiated locally, with different providers and plans available, specific changes for each person can’t be addressed in this overview. What we do know is that the state will be adding more than $400 million in new funding towards educator health care.

SEBB program benefits will include:

For other details, see these fact sheets created by the state Health Care Authority.