Frequently Asked Questions (FAQs)
How do I become eligible for healthcare coverage?
You are eligible for personal health coverage with SEIU 775 Healthcare NW Health Benefits Trust after you work for a minimum of 80 paid hours per month for at least two months in a row and your monthly co-premium payment is received. To stay eligible for your coverage, you must continue to work at least 80 hours per month and continue to pay your monthly co-premium payment.
If you work 120 hours or more per month, you are eligible to enroll your dependent(s) in $10 dental. To stay eligible for $10 dental coverage for your dependent, you must continue to work at least 120 hours per month.
How do I apply for healthcare coverage?
There are 2 easy ways to apply for healthcare coverage for yourself and eligible dependent children:
Online with Health: My Plan
Fill out an online application using Health: My Plan. Visit myseiu.be/faq-my-planto learn more.
Fill out the Health Benefits Application and m ail it in an envelope with your return address to:
SEIU 775 Benefits Group
PO Box 24811
Seattle, WA 98124
If you do not receive confirmation of enrollment or plan changes within 30 days of submitting your application, call SEIU 775 Benefits Group Customer Service at 1-877-606-6705.
When can I apply for healthcare coverage?
There are 3 times you can apply for coverage:
- When you are newly eligible: within 60 days of the date on your newly eligible enrollment packet.
- During Open Enrollment: July 1 – 20 each year if you meet the eligibility criteria.
- You have a Qualifying Life Event (QLE): within 30 days of a QLE that changes your health insurance needs.
- Examples of Qualifying Life Events include loss of other health insurance coverage or birth or adoption of a child, among others. For more information onQualifying Life Events, please call Customer Service at 877-606-6705.
Can I enroll my dependent children in coverage?
You can enroll eligible children (through their 26th birthday) in dependent coverage. Your eligibility is based on how many hours you work per month. When enrolling, you can choose:
- The 80 Hour Option, which includes full medical and dental coverage at the full premium cost.
- or the 120 Hour Option, which includes full medical and $10 dental coverage or $10dental coverage only
If you choose to enroll your dependent(s), you will need to submit an application for benefits during an allowed enrollment window along with dependent verification documentation. View a list of qualified dependents.
What is Dependent Verification?
If you choose to add dependents to your coverage, you will need to fill out the dependent section of the Health Benefits Application and send a document that verifies their relationship to you. Your application is not complete until you submit your Dependent Verification—you can do this at the same time you submit your application, but if your application is received within your enrollment window, you have an additional 60 days to verify your dependent. View a list if acceptable documents.
When will my coverage start?
If you meet eligibility criteria and your completed application is received on or before the 15th of the month, your coverage will begin on the 1st of the following month.
- Example: if an application is received between January 1 and 15, coverage will begin on February 1.
If your application is received between the 16th and 31st of the month, your coverage will begin on the 1st of the month after the following month.
- Example: if an application is received between January 16 and January 31, coverage will begin on March 1.
During Open Enrollment ( July 1 – 20 every year):
Your application and changes must be received on or before July 20 to be processed for coverage beginning August 1.
If you have a Qualifying Life Event:
To enroll or make changes because of a Qualifying Life Event, contact SEIU 775 Benefits Group within 30 days.
- Example: If you have a child on January 1, you have until January 31 to contact SEIU 775 Benefits Group about enrolling yourself and/or your children.
When will my dependent’s coverage start?
Your dependent’s coverage will start after:
- You submit a completed application and dependent verification documentation within an allowed enrollment window.
- You work the number of hours matching your coverage election.
- Your monthly co-premium payment has been received.
If you fall below the hours required for your dependent coverage option or do not pay your co-premium, coverage for your dependent will be dropped.
Which medical plan am I on?
Your medical plan is assigned based on your zip code.
If you live in the Kaiser Permanente Service Area (within 30 miles of a Kaiser Permanente of Washington (KPWA) or a Kaiser Foundation of the Northwest (KPNW) network provider), you are enrolled in either the KPWA or KPNW plan, depending on your ZIP code. If you are outside the Kaiser Permanente Service Area (KPWA and KPNW), you are enrolled in the Aetna plan.
NOTE: If you change your address, your medical plan may change. If your plan needs to change based on your new address, you will be notified in writing of the plan change.
Can my children and I have different medical or dental plan elections?
If you enroll your dependent children into coverage, they will be enrolled in the same plan that you are on.
Can my child be enrolled under both myself and my spouse?
You and your family may be enrolled in benefits through the SEIU 775 Healthcare NW Health Benefits Trust only one time. Your dependent’s coverage can be coordinated with other outside healthcare coverage. For more information, please call SEIU 775 Benefits Group Customer Service at 1-877-606-6705.W
What if my hours are reported to my employer late?
Hours worked must be reported to your employer within 60 days of the date worked to be used in the calculation of benefit eligibility. Your employer will report your hours worked to SEIU 775 Benefits Group. If your hours are reported late, hours will be recorded but coverage will not be extended.
- Example: hours worked in January must be reported to your employer by March 31, and received by SEIU 775 Benefits Group from your employer no later than April 20 to ensure March coverage.
What if I cannot work the hours needed to maintain my and/or my dependent’s coverage?
If you are enrolled in healthcare coverage, but fall below 80 hours in any month, you will lose your healthcare coverage.
- Example: If you do not work 80 hours in January, healthcare coverage will end on March1 (unless you decide to self-pay for COBRA coverage).
If you lose coverage because you do not work 80 hours one month, but work 80 or more hours the following month, you will be automatically re-enrolled in health coverage the following month. If you have a break in coverage for more than 12 months, you will need to re-establish initial eligibility and fill out a new application to return to the health plan.
If you fall below the required hours for your Dependent Coverage Option i n any month, your dependent’s coverage will stop until your hours go back up.
- Example: If your dependent is enrolled in the 120 hours Dependent Coverage Option and you do not work at least 120 hours in January, coverage for your dependent will end on March 1.
What happens if my monthly co-premium is not deducted from my paycheck?
If your co-premium is not able to be deducted from your paycheck, you will receive a self-pay notice to make the payment by PayPal using Health: My Plan, or by check or money order. If payment for your dependent coverage is not made, coverage will be dropped.
Mail your check or money order along with the self-pay tear-off to:
SEIU 775 Benefits Group
PO BOX 5349
Carol Stream, IL 60197-5349
What is a waiver?
If you do not want to enroll in health coverage or would like to end your coverage and/or your dependent’s coverage (if you and/or your dependent are already enrolled), you can fill out the Waive Coverage form. If you choose to waive coverage, you will not be able to enroll again until the next Open Enrollment period (every year July 1-20) or if you have a Qualifying Life Event.
If you submit a waiver on or before the 15th of the month, your and/or your dependent’s coverage will end on the 1st of the next month. If you submit a waiver between the 16th and 31st of the month, your and/or your dependent’s coverage will end on the 1st of the second month.
- Example: If you submit a waiver between January 1 and January 15, your coverage will end on February 1. If you submit a waiver between January 16 and January 31, your coverage will end on March 1.