SEBB LTD Administration Manual

Employer-paid and Employee-paid

Long-Term Disability (LTD) Insurance

SEBB Administration

Manual

for SEBB

Benefits Administrators

 
 
Revised: August 2022                                                         SEBB LTD Administration Manual                     2 
 
Table of Contents 
Introduction ................................................................................................................................................ 3 
Plan Reference Information ........................................................................................................................ 4 
Forms .......................................................................................................................................................... 5 
Eligibility ..................................................................................................................................................... 6 
Application Procedures ............................................................................................................................... 6 
EOI approval is not required when.......................................................................................................... 6 
Employer procedures .......................................................................................................................... 6 
EOI approval is required when ................................................................................................................ 7 
Employer procedures .......................................................................................................................... 7 
After the EOI decision ............................................................................................................................. 7 
LTD EOI approval or declination letter ........................................................................................................ 8 
Employees Returning from Approved Leave ............................................................................................... 9 
Claim Procedures ...................................................................................................................................... 10 
Employer-paid LTD Billing Administration………… …………………………………………………………………………………..13 
Employee-paid LTD Billing Administration……………………………………………………………………………………………..13 
Appendix ................................................................................................................................................... 17 
Employee Enrollment and change form sample…………………………………………………………………………………17 
EOI approval or declination letter ......................................................................................................... 18 
Employer-paid coverage letter sample ................................................................................................. 20 
Employee-paid coverage letter sample................................................................................................. 23 
 
 

Revised: August 2022 SEBB LTD Administration Manual 3

Introduction

This manual is intended for use as a reference tool only. The purpose of this manual is to assist you in

the administration of the Long-Term Disability (LTD) benefit plan. If there is inconsistency with this

manual and the LTD Plan Booklet, the LTD Plan Booklet takes precedence.

If you have questions about eligibility or enrollment, please contact:

Outreach and Training

1-800-700-1555 | HCA Support

Benefits are underwritten by Standard, Portland, OR. For the purposes of this manual, The Standard

Insurance Company will be referred to as “Standard.”

Reminders:

• After January 1, 2022, an employee at any time may elect to reduce employee-paid LTD to the 50%

coverage plan without Evidence of Insurability (EOI) or fully decline employee-paid LTD. The effective

date of the change in coverage will be the first day of the month following the date the employer

receives the election.

• An employee who seeks to increase coverage from the 50% coverage plan to the 60% coverage plan,

or access previously declined employee-paid LTD, will be subject to EOI. The effective date of the

change in coverage will be the day of the month the contracted vendor approves the required form.

• LTD premiums are NOT based on a monthly salary that is over $16,667. For example, if an employee

makes more than $16,667 a month, they are only able to insure up to $16,667 of their income on a

monthly basis.

• SEBB My Account manuals can be found at https://www.hca.wa.gov/sebb-benefits-admins/manuals.

• More LTD information & resources can be found at https://www.hca.wa.gov/sebb-benefits-admins.

Revised: August 2022 SEBB LTD Administration Manual 4

Plan Reference Information

Policyholder:

Washington State Health Care Authority

Group Policy Number:

756494-A

Group Policy Effective Date:

January 1, 2020 and as amended

Eligibility or Enrollment

Questions:

Outreach and Training Phone:

1-800-700-1555

Email: HCA Support

Claims: Employers will submit paper employer statements. Employees can use one of the methods

below to submit a claim.

Telephonic:

Mail:

1-833-229-4177

The Standard Insurance Company

Employee Benefits Department

PO Box 2800

Portland, OR 97208-2800

Fax:

971-321-8400

Online:

www.standard.com

(To file a claim online, go to the above address and click on “File a

Group Insurance Claim” on the middle right side of the screen to

begin the claim process. Instructions will be provided through the

entire claim submission process.)

Revised: August 2022 SEBB LTD Administration Manual 5

Forms

Forms are available at the SEBB Benefits Administrator website.

Download:

From the menu on the left, Forms and Publications > Long-term disability (LTD insurance):

Long-Term Disability LTD Booklet

Long-Term Disability Enrollment/Change form

Long-Term Error or Discrepancy Correction form

Long-Term Disability Evidence of Insurability form

Long-Term Disability Claim Packet

Revised: August 2022 SEBB LTD Administration Manual 6

Eligibility

• School employees eligible for the employer contribution toward SEBB benefits as described in WAC

182-31-040 are eligible for and will be automatically enrolled in Employer-paid LTD insurance and

Employee-paid LTD insurance. The school employee can reduce or decline Employee-Paid LTD

insurance at any time.

• School employees eligible under WAC 182-30-130 are not eligible for employer-paid or employee-

paid LTD insurance.

Employer-paid LTD insurance is paid by the employer. Employee-paid LTD insurance is paid by the

school employee.

Application Procedures

EOI approval is not required when:

The school employee:

• Makes elections in SEBB My Account or submits the Long-Term Disability Enrollment/Change form no

later than 31 days after the date of initial eligibility; or

• Requests to reduce or decline their Employee-paid LTD insurance.

Employer process when a school employee submits a paper form:

1. Review the LTD Enrollment/Change form for accuracy. Ensure the school employee has completed

the appropriate sections and signed and dated the form.

2. Complete the To Be Completed by Employee’s Payroll or Benefits Office Staff section of the form.

a. Employee-paid LTD insurance is effective as follows:

If the school employee’s first day of work is on or after September 1st, but not later than the

first day of school for the current school year as established by the Employer, they are

eligible for the employer contribution on their first day of work. The school employee’s

Employer-paid LTD insurance will begin the first day of work. If the school employee is

eligible at any other time, the school employee’s Employer-paid LTD insurance will begin the

first of the month following the date the school employee becomes eligible for the

employer contribution toward SEBB benefits.

Revised: August 2022 SEBB LTD Administration Manual 7

3. Enroll the school employee in Employee-paid LTD insurance in SEBB My Account.

4. File the original enrollment/change form in the school employee's file. Do not forward the enrollment

form to Standard.

Note: SEBB My Account automatically calculates the LTD effective date, based on the date you enter the

enrollment. If you are delayed in entering the enrollment in SEBB My Account, contact Outreach and Training

before you enter it into the system. If back Employee-paid LTD insurance premiums are due, notify the school

employee and collect the back Employee-paid LTD insurance premiums.

EOI approval is required when:

The school employee increases coverage or applies for coverage after previously declining Employee-Paid LTD

insurance after their first 31 days of initial eligibility.

• The school employee must complete both the LTD Enrollment/Change form and the Evidence of

Insurability form. The LTD Enrollment/Change form must be submitted to the school employee’s

Employer and the Evidence of Insurability form to Standard for approval.

Employer process:

If the school employee submitted a paper form, review the LTD Enrollment/Change form for accuracy.

Ensure the school employee has completed the appropriate sections and signed and dated the form.

1. Complete the To Be Completed by Employee’s Payroll or Benefits Office Staff section of the form.

2. Remind the school employee to send the Evidence of Insurability form to Standard. If the school

employee submitted the form to you with the enrollment/change form, you may send the Evidence of

Insurability form to Standard.

Note: Standard Insurance Company does not require a copy of the enrollment/change form when

carrier evidence of insurability approval is required. Do not send Standard the enrollment/change

form.

3. File the original enrollment/change form in the school employee's file.

After the EOI decision:

1. The Employer and school employee will receive an EOI approval or declination letter from

Standard when the underwriting of the application has been completed.

2. Review the letter for accuracy and verify EOI approval was required. Contact Standard if

approval was not required.

3. If the EOI was approved, check the Employee-paid LTD insurance box in SEBB My Account. The

effective date of the coverage is the day of the month Standard approves the required form

and the new LTD premium deduction will begin the first of the month following the effective

date of the coverage. Refer to the SEBB My Account Manual for instructions.

Note: SEBB My Account automatically calculates the LTD effective date. Based on the date you enter the

enrollment. If you are delayed in entering the enrollment in SEBB My Account, contact Outreach and

Revised: August 2022 SEBB LTD Administration Manual 8

Training before you enter it into the system. If back Employee-paid LTD insurance premiums are due, notify

the school employee and collect the back Employee-paid LTD insurance premiums.

4. If the EOI was denied, no action is necessary in SEBB My Account as the school employee will

not have Employee-paid LTD insurance per Standard’s denial.

5. Attach the Employer copy of the EOI approval or declination letter to the LTD

Enrollment/Change form and place in the school employee's file.

LTD EOI approval or declination letter

A letter will be issued by Standard when a school employee applies to increase coverage or applies for coverage

after previously declining Employee-Paid LTD insurance after the first 31 days of initial eligibility.

When Standard makes a decision, an EOI approval or declination letter will be issued to the

Employer and the school employee.

The EOI approval or declination letter indicates if the coverage is approved, denied, or the request is

closed. A request may be closed if Standard does not receive all requested information from the school

employee in a timely manner. Standard may re-open a closed request when it receives the information.

Below are some special circumstances that may arise upon receiving the EOI approval or declination letter:

1. LTD insurance was declined, but school employee enrolled no later than 31 days after the date of

eligibility*.

When you receive an EOI approval or declination letter, check the date of eligibility and the date

the school employee elected Employee-paid LTD insurance in SEBB My Account or the hire

date/date of eligibility and the date the employer receives the enrollment form. Approval is not

required when the school employee elects Employee-paid LTD insurance or submits the form no

later than 31 days after the date of eligibility. If you receive an EOI approval or declination letter

for an application that did not require approval, call Standard, explain the situation, and request

Standard change their records.

Note: SEBB My Account automatically calculates the LTD effective date. Based on the date you enter the

enrollment. If you are delayed in entering the enrollment in SEBB My Account, contact Outreach and

Training before you enter it into the system. If back Employee-paid LTD insurance premiums are due,

notify the school employee and collect the back Employee-paid LTD insurance premiums.

2. If you receive a closure or denial and at a later date, receive an approval, overturning the previous

decision, enter the approval in SEBB MyAccount. If you have any questions regarding the approval,

contact Standard.

Note: SEBB My Account automatically calculates the LTD effective date. Based on the date you enter

the enrollment. If you are delayed in entering the enrollment in SEBB My Account, contact Outreach

Revised: August 2022 SEBB LTD Administration Manual 9

and Training before you enter it into the system. If back Employee-paid LTD insurance premiums are

due, notify the school employee and collect the back premiums.

*First 31 days of eligibility – The 31 days begins on the first day the school employee is

eligible for the employer-contribution toward SEBB benefits.

School Employees with Approved Leave

If a school employee lost eligibility for the employer contribution and regains eligibility when returning from

leave:

1. Reinstate Employer-paid and Employee-paid LTD insurance effective the first day of the month in

which the school employee regains eligibility for the employer contribution toward SEBB Benefits.

*Note: School employees who are on an approved leave of absence can continue their long-term disability

(LTD) insurance as long as they are eligible for the employer contribution (meaning that they have already

worked at least 630 hours or are still anticipated to work 630 hours during the school year). If they are not

eligible for the employer contribution, then LTD insurance cannot be continued per WAC 182-31-100.

For school employees on an approved leave of absence who will maintain eligibility for the employer

contribution (by working the 630+ hours/year):

• Employer-paid LTD insurance is continued with premium payment paid by the Employer for the

remainder of a given school year, as long as the school employee is eligible for the employer

contribution and works or is anticipated to work 630 hours or more per year.

• For Employee-Paid Insurance: During a Leave Of Absence (providing that the school employee

maintains eligibility for Employer-Paid Insurance), the following will apply:

o During the first 90 days insurance will be continued, and premium payments are waived for

Employee-Paid Insurance. Premiums for Employer-Paid Insurance will continue to be remitted

by the Employer.

o Beginning on day 91 and continued through the end of the School Year, insurance will

continue providing premium payments are remitted by the employee to the Employer.

*Note: When you have a benefits eligible employee who is enrolled in employee paid LTD and who maintains

their eligibility for SEBB benefits after going on a leave of absence, you will need to make an adjustment to

your payroll system (not SMA) so you don’t take a deduction for the employee for up to 90 days. Once the 90-

day period has been reached, you should adjust your payroll system to start taking the deduction again

(assuming they are still on a leave of absence at that time and still eligible for SEBB benefits). The SMA

monthly billing file only reflects who is enrolled in LTD which means that you will continue to see the LTD

“coverage rate” for that employee on your SMA monthly billing invoice during that 90-day period. Do not

term the employee paid insurance in SMA to avoid seeing the rate on your invoice, because when you then

attempt to re-enroll them back into their coverage, they will now be required to provide EOI.

Revised: August 2022 SEBB LTD Administration Manual 10

Claim Procedures

LTD claims should be filed as soon as the school employee's last day (physically) on the job is known. Do

not wait for leave to be exhausted to file the claim. Leave balances are verified for purposes of

determining when the benefit payment period begins.

Employers will submit paper employer statements. School employees have three options to file a claim:

• Telephone

• Online

• Paper

Telephonic Claims

Employee process:

1. School employee to call the toll-free number 1-833-229-4177.

2. The Standard Intake Unit will interview the school employee and complete the employee statement of

the claim form. School employee will receive a claim number at the end of the call and an

acknowledgement letter is sent either through email or USPS. The employee is asked to have their

employer complete the hard copy employer statement.

Online Claims

Employee process:

1. Go to www.standard.com. Create an account (if the employee doesn’t already have one).

2. Click on “File a Group Insurance Claim” on the middle right side of the screen to begin the claim process.

Instructions will be provided through the entire claim submission process. The employee will be asked to

have their employer complete the hard copy employer statement.

Paper Claims

Employer process:

1. Complete the State of Washington Long-Term Disability Claim Employer's Statement.

• Section 1 – Enter the school employee's personal information. Include the school employee's

job title and job classification. The job classification information should include whether the

school employee is full-time, part-time, permanent, temporary, etc.

• Section 2 – Include all benefit and work information.

Revised: August 2022 SEBB LTD Administration Manual 11

• Section 3 – Enter the school employee’s salary information—current salary, previous

salary, and the effective date of the last increase. Salary information may be entered as

weekly, hourly, monthly, or an annual rate.

• Section 4 – Include all banked sick leave, shared leave, and annual leave.

• Section 5 – Answer all questions.

• Section 6 – Answer “No” to the first question. HCA does not purchase the school

employee life insurance through Standard.

• Section 8 – Complete the employer information.

2. Send the completed Long-Term Disability Employer's Statement to Standard. Include copies of the

school employee's LTD Enrollment/Change form, if a paper form(s) are available, and the

requested documentation in section 7 of the Employer’s Statement.

Standard has the following minimum requirements for documenting pre-disability earnings (PDE):

• Payroll documentation is not required if the school employee’s PDE is less than

$5,000 per month.

• If the school employee’s PDE is from $5,000 to $8,999 per month, payroll

documentation is required from the school employee’s last day worked and the three

calendar months prior to the date of disability.

• If the school employee’s PDE is $9,000 and above payroll documentation is

required from the 12 months prior to the last day worked and continuing to the

most recent day paid plus a copy of the school employee’s prior year W2.

Payroll information is defined as payroll records, pay stubs, or other documents

produced via a payroll software system. Payroll information must include year- to-date

information wherever available.

Long-Term Disability Claim Submission Options:

• Mail to Standard Insurance Company at PO Box 2800, Portland OR, 97208-2800

• Employer statement

• Enrollment/Change form

• Any required PDE documents

• Fax the forms to 971-321-8400

• Employer statement

• Enrollment/Change form

• Any required PDE documents

Revised: August 2022 SEBB LTD Administration Manual 12

• Send the School Employee’s Statement to the school employee.

• School Employee's Statement - The school employee should complete and return this form

to Standard with attached copies of requested documents. (See the instructions on the first

page of form). Included in the School Employee's Statement are:

• Authorization to Obtain Information – School employee must sign and date this form

and return with the School Employee's Statement

• Authorization to Obtain Psychotherapy Notes -School Employee must sign and date

this form and return with the School Employee's Statement

• Attending Physician's Statement - Part A is completed by the school employee. Part B is

completed by the school employee's physician. The physician must return this to

Standard.

3. Continue to collect the Employee-paid LTD insurance premiums until you receive Standard’s decision.

Employee process:

Employee will follow the instructions on the claim packet.

After the EOI decision:

1. Standard will send a copy of the coverage letter to the Employer and school employee. If approved,

the school employee will receive payment with the EOB.

2. If approved and the school employee is still active, the Employer will refund any Employee-paid

LTD insurance premiums as applicable for the approved claim to the school employee.

Returning to work after a disability claim:

The Employer must notify Standard any time there is a change in work status of the school employee.

• If the school employee returns to work part-time

• If the school employee returns to work part-time, then returns to full-time

• If the school employee returns directly to full-time

When the school employee returns to work full-time, regular duties, the employer will reinstate

Employee-paid LTD insurance, effective the first day of the month following the day the school

employee returns to work. Refer to the SEBB My Account Manual for instructions. If coverage is not re-

entered, premiums will not be deducted, and coverage will not be reinstated.

An LTD Employee Enrollment/Change form is not required when the school employee returns to

work. Enroll the school employee in the same coverage as before the claim. If the school employee

Revised: August 2022 SEBB LTD Administration Manual 13

would like to change coverage, refer to the Application Procedures section earlier in this manual.

Employer-paid LTD insurance Billing Administration

The Employers are responsible for paying HCA the Employer-paid LTD insurance premiums. HCA will then pay

Standard for all employer contributions for the Employer-paid LTD insurance. Employers will remit payment

to -Standard for the Employee-paid LTD Insurance only.

Employee-paid LTD insurance Billing Administration

Employee-paid LTD insurance Premiums:

Employee-paid LTD insurance billing will be handled on a self-administered basis (this means that the

Employers are the record keepers). Since LTD insurance is an income replacement plan (income based), the

Employers are responsible for deducting premium payments from school employees’ paychecks based on

each school employee’s Insured Earnings.

Insured Earnings is defined as the first $16,667 of each eligible school employee’s monthly pre-disability

earnings (for a 12-month billing cycle). Insured Earnings includes any additional time, responsibility, and

incentive (TRI Pay) earnings and is also defined as a school employee’s gross monthly rate of earnings from

their Employer. Insured Earnings does not include bonuses, commissions, overtime pay, shift differential pay,

optional stipends, or any other extra compensation. If a school employee is paid hourly, their monthly rate of

earnings is based on the number of hours the school employee is regularly scheduled to work per month, but

not more than 173 hours. If a school employee does not have regular work hours, the monthly rate of

earnings is based on the average number of hours worked per month during the preceding 12 calendar

months (or during the period of employment if less than 12 months), but not more than 173 hours.

If your SEBB organization works with WSIPC and you need help setting up TRI Pay in the Skyward system to

correctly calculate LTD premiums, please contact your Information Support Center or District Finance

Coordinator.

HCA will provide Employers the following LTD information on the SMA Monthly Billing File beginning 4/16/22:

• Employee-paid LTD enrollment by plan indicator:

o Valid values are:

▪ D (default 60 % coverage)

▪ B (buydown 50% coverage)

▪ N (decline, not enrolled)

• 60% coverage rates and 50% coverage rates as applicable through the SEBB MyAccount (SMA) billing

file.

Revised: August 2022 SEBB LTD Administration Manual 14

The Employers will take the Employee-paid LTD insurance rates provided by HCA and multiply it by the school

employee’s Insured Earnings (including TRI Pay earnings) to calculate the Employee-paid LTD insurance

premium that will be deducted from the school employee’s paycheck. Premium payments for the Employee-

paid LTD insurance will be taken through post-tax employee payroll deductions by Employers. The Employers

will be responsible for submitting monthly Employee-paid LTD insurance premium payments to Standard.

Employers can use the on-demand Employee-Paid LTD Enrollment Changes report in SMA to obtain a list of

which LTD plan employees are enrolled in. Please note that the Employee-Paid LTD Enrollment Changes

report is a real-time report, with the latest LTD enrollment changes. It is NOT a snapshot in time, like the

monthly billing file. HCA is currently exploring the possibility of adding a timestamp to the Employee-Paid LTD

Enrollment Changes report (this would give Employers the ability to pull the report from a specific date) and a

column with the employee’s full SSN.

Below is a sample of the Employee-Paid LTD Enrollment Changes report:

The SEBB rates are as follows:

Revised: August 2022 SEBB LTD Administration Manual 15

Standard resources for how to remit employee-paid LTD premiums to Standard:

• LTD Premium Calculation Job Aid (SI 22626-756494)

https://www.standard.com/eforms/22626_756494.pdf

• Invoice Job Aid Sample (SI 22627-756494)

https://www.standard.com/eforms/22627_756494.pdf

• AdminEASE Online Bill Pay Customer Support Job Aid (SI 22628-756494)

https://www.standard.com/eforms/22628_756494.pdf

• Premium Payment Letter (SI 22629-756494)

https://www.standard.com/eforms/22629_756494.pdf

Employee-paid LTD insurance Premium Due date:

Employee-paid LTD insurance premiums are due for the current month. For example, Employee-paid LTD

insurance premium for January is due January 1

. There is a 60 day grace period. Premium is due to Standard

no later than 60 days after the first of the month in which payment is for.

Refunding Employee-paid LTD insurance premiums when necessary:

Employers will refund the premium to the school employee(s) when appropriate according to SEBB Program

Rules and the SEBB LTD Policy. The Employer should then take a credit on the next billing statement and

payment to Standard in an amount that is equal to and reflects the premium refund provided to the school

Revised: August 2022 SEBB LTD Administration Manual 16

employee(s). Employers should provide the credit amount taken on the billing statement as a separate line

item as well as a description of what the credit is for.

Standard contact info for Employee-paid LTD insurance billing questions:

All billing related inquiries and remittance can be directed to: SEBBbi[email protected]

Primary Billing Contact:

Cindy Bofinger

[email protected]

971.321.4653

Employee-paid LTD insurance Payment Options with Standard:

• AdminEASE Online Bill Pay Option

• Paper/Check/ACH/Wire Transfer Option

Revised: August 2022 SEBB LTD Administration Manual 17

Appendix

Enrollment and change form sample

Revised: August 2022 SEBB LTD Administration Manual 18

EOI approval or declination letter sample

Revised: August 2022 SEBB LTD Administration Manual 19

Revised: August 2022 SEBB LTD Administration Manual 20

Explanation of benefits samples

Employer-paid coverage letter sample

Revised: August 2022 SEBB LTD Administration Manual 21

Revised: August 2022 SEBB LTD Administration Manual 22

Revised: August 2022 SEBB LTD Administration Manual 23

Employee-paid coverage letter sample

Revised: August 2022 SEBB LTD Administration Manual 24

Revised: August 2022 SEBB LTD Administration Manual 25