182-31-110  <<  182-31-140 >>   182-31-150

WAC 182-31-140

Who are eligible dependents?

To be enrolled in a health plan, a dependent must be eligible under this section and the subscriber must comply with enrollment procedures outlined in WAC 182-31-150.
The school employees benefits board (SEBB) program will verify the eligibility of all self-pay subscriber dependents and will request documents that provide evidence of a dependent's eligibility. The SEBB program reserves the right to review a dependent's eligibility at any time. All SEBB organizations will verify the eligibility of all school employee dependents and will request documents that provide evidence of a dependent's eligibility. The SEBB program and SEBB organizations will not enroll dependents into a health plan if they are unable to verify a dependent's eligibility within the SEBB program enrollment timelines.
A self-pay subscriber must notify the SEBB program, in writing, when their dependent is not eligible under this section. A school employee must notify their SEBB organization, in writing, when their dependent is not eligible under this section. The notification must be received no later than sixty days after the date their dependent is no longer eligible under this section. See WAC 182-31-150(2) for the consequences of not removing an ineligible dependent from SEBB insurance coverage.
The following are eligible as dependents:
(1) Legal spouse. Former spouses are not eligible dependents upon finalization of a divorce or annulment, even if a court order requires the subscriber to provide health insurance for the former spouse;
(2) State registered domestic partner. State registered domestic partner as defined in RCW 26.60.020(1) and substantially equivalent legal unions from other jurisdictions as defined in RCW 26.60.090. Former state registered domestic partners are not eligible dependents upon dissolution or termination of a partnership, even if a court order requires the subscriber to provide health insurance for the former partner;
(3) Children. Children are eligible through the last day of the month in which their twenty-sixth birthday occurred except as described in (f) of this subsection. Children are defined as the subscriber's:
(a) Children of the school subscriber based on establishment of a parent-child relationship as described in RCW 26.26.101, except when parental rights have been terminated;
(b) Children of the subscriber's spouse, based on the spouse's establishment of a parent-child relationship as described in RCW 26.26.101, except when parental rights have been terminated. The stepchild's relationship to the subscriber (and eligibility as a dependent) ends on the same date the marriage with the spouse ends through divorce, annulment, dissolution, termination, or death;
(c) Children of the subscriber's state registered domestic partner, based on the state registered domestic partner's establishment of a parent-child relationship as described in RCW 26.26.101, except when parental rights have been terminated. The child's relationship to the subscriber (and eligibility as a dependent) ends on the same date the subscriber's legal relationship with the state registered domestic partner ends through divorce, annulment, dissolution, termination, or death;
(d) Children for whom the subscriber has assumed a legal obligation for total or partial support in anticipation of adoption of the child;
(e) Children specified in a court order or divorce decree for whom the subscriber has a legal obligation to provide support or health care coverage;
(f) Children of any age with a developmental or physical disability that renders the child incapable of self-sustaining employment and chiefly dependent upon the subscriber for support and maintenance provided such conditions occurs before the age of twenty-six:
(i) The subscriber must provide proof of the disability and dependency within sixty days of the child's attainment of age twenty-six;
(ii) The subscriber must agree to notify the SEBB program, in writing, no later than sixty days after the date that the child is no longer eligible under this subsection;
(iii) A child with a developmental or physical disability who becomes self-supporting is not eligible under this subsection as of the last day of the month in which they become capable of self-support;
(iv) A child with a developmental or physical disability age twenty-six and older who becomes capable of self-support does not regain eligibility if they later become incapable of self-support; and
(v) The SEBB program with input from the applicable contracted vendor will periodically verify the eligibility of a dependent child with a disability beginning at age twenty-six, but no more frequently than annually after the two-year period following the child's twenty-sixth birthday, which may require renewed proof from the subscriber.
(g) Extended dependent in the legal custody or legal guardianship of the subscriber, the subscriber's spouse, or the subscriber's state registered domestic partner. The legal responsibility is demonstrated by a valid court order and the child's official residence with the custodian or guardian. Extended dependent child does not include a foster child unless the subscriber, the subscriber's spouse, or the subscriber's state registered domestic partner has assumed a legal obligation for total or partial support in anticipation of adoption.
[Statutory Authority: RCW 41.05.021, 41.05.160 and SEBB policy resolutions. WSR 19-01-055 (Admin #2018-01), ยง 182-31-140, filed 12/14/18, effective 1/14/19.]
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